The transition process often involves much more than just plunking down a new food item.  Time, patience and tricks are often required.

One reason that cats like dry food so much is because the pet food companies do not play fair when manufacturing this sub-optimal food source.  They coat the kibble with extremely enticing animal digest sprays that are very pleasing to a cat – making a poor quality diet very desirable to the target animal.

In addition to the aforementioned coating of dry food with animal digests, another issue is one of a crunchy texture, which is very different from canned food.  Cats are very resistant to such a drastic change in the texture of their food.

If you are convinced that getting your cat off of dry food is the way to go, read on for some tips on how to accomplish this.

The key is to do it slowly and with patience and incorporate various tricks for the stubborn cats. The most important issue is actually making the change, not how fast you accomplish it. 

I must say that my cats tested every ounce of patience I had over a 3+ month period of time during their transition from dry to canned food.  They had been on dry food their entire lives and did not recognize canned food as food.  My cats ranged in age from 2 years to 10 years at the time of the transition.

The single biggest mistake I see people make time and again is to say that their cat “won’t touch” the new food and then panic and fill up the bowl with dry food.  In many cases, it is simply not that easy to get cats off of dry food.

There are two categories of cats – those that will eat canned food and those that will be extremely resistant to eating anything other than dry food.  If your cat falls into the first category, lucky you. These cats will take to it with the attitude of “finally – an appropriate diet for my species.” In this case, if your cat has been on all dry food, or only receives canned food as an occasional ‘treat,’ start by feeding canned food in increasing amounts.  Gradually decrease the dry, taking about a week to fully switch the cat over to 100 percent canned food.

Some cats may experience softer stools during the transition.  I do not worry if this happens and tend to ‘ride it out.’  If diarrhea results from the diet change you will either need to experiment with different canned foods or slow the transition down and do it over a period of several weeks.

Note that in over 40 years spent in this profession, I have never met a cat that needed dry food to stay healthy but some need to be transitioned more slowly than others.

The average cat should eat about 180 – 220 calories per day which will be found in 5-6 ounces of the average canned food.

However, note that high protein/low fat/low carb foods like Weruva Paw Lickin’ Chicken and some Tiki Cat varieties are very low in calories (see the Cat Food Composition chart, far right column) so you will need to feed much more than 5-6 ounces which can get quite expensive.

The necessary daily caloric intake should be split between 3 to 4 meals/day (or just free-fed if they are not overweight).

When determining how much you should be feeding your cat once transitioned to canned food, keep it simple.  Too fat?  Feed less.  Too thin?  Feed more.

Now….for the stubborn cats……

If you are unlucky like I was, and your cat does not recognize the fact that he is a carnivore and would live a healthier life if eating canned food, (or a homemade diet) then you will have some work to do.  Some cats that have been on dry food for their entire life will be quite resistant to the diet change and may take several weeks or longer to make the transition to a healthier diet.

For ‘resistant-to-change’ cats, you will need to use the normal sensation of hunger to help with the transition. For this reason, it is very important to stop free-feeding dry food.  This is the first, and very critical, step.  You need to establish set mealtimes. They are not going to try anything new if their bowl of junk food is in front of them 24/7.

Cats do not need food available at all times. It really is okay for them to experience a hunger pain!  That said, it was very hard for me to listen to my cats begging for food even though I was strong in my conviction that I was heading them in the best direction for optimal health. It truly was a stressful time for me and them.  Actually, I think it was harder on me!

This is where many people fail and just give in and fill up the dry food bowl.  There were a few times when I had to call my ‘sponsor’ and was instructed to “just leave the house if you can’t take looking into those eyes!”  I left the house. Those pitiful little cries of “I have not had food for two WHOLE hours!” were hard to take.  But, lo and behold, they were just fine when I returned.  Not one cat had died from hunger.

On the other hand, do not attempt to withhold food for long periods of time (greater than 24 hours) with the hope that your cat will choose the new food.  You need to ‘convince’ them that a high quality canned food  really is good for them, rather than to try starving them into it – which does not work anyway.  Allowing a cat to go without food – especially an overweight cat – for a long period of time (greater than 48 hours) can be quite dangerous and may result in hepatic lipidosis (fatty liver disease).

Hepatic lipidosis can also develop when a cat consumes 50 percent or less of his daily caloric requirements over a period of many days.  The definition of “many” varies from cat-to-cat.  For this reason it is important to understand that you need to have some idea of the calories from canned food combined with the calories from dry food that your cat is consuming on a daily basis while you are implementing the transition to canned food.

I have never seen a cat develop hepatic lipidosis when consuming at least 15 calories per pound per day. This number is figured on lean body weight, not fat weight.

If your cat weighs 18 pounds but really should weigh 12 pounds, please make sure that he is consuming about 180 calories per day.  (12 pounds lean body mass X 15 calories/pound/day = about 180 calories/day)

In reality, the cat in the above example would probably be completely safe at only 150 calories per day.

If you have a small female cat that should only weigh 9 pounds, please make sure that she is consuming at least 135 calories per day.

Canned foods never list the calorie content on the can but many dry foods do list this information on the bag.  A rough guideline for the calorie content of most canned foods that are 78 percent moisture is about 30 calories per ounce, but can range from 20 to 40 calories/ounce as shown by the chart linked above.

Most cats will lose some weight during the transition to canned food.  Given that a very high percentage of cats are overweight to begin with, this is a favorable result of the diet change – as long as they do not lose too much weight too fast.  A cat should never lose more than one to two percent of body weight per week.

I highly suggest that all cat caregivers weigh their cats periodically, especially if they are over 10 years of age.  This will help ensure a safe transition to a healthier diet and, in general, weight loss is often the first sign of ill health for any reason.  I make it a point to weigh my cats at least once each month, especially since they are now over 10 years of age.

Here is a scale that is reasonably priced:  Salter Baby and Toddler scale. It weighs to the nearest half ounce and has a ‘hold’ button on it that helps obtain an accurate weight even for a cat that is moving around a bit.

Here is another scale that may be even better because its base is as long as the scale.  Red Cross Baby Scale. This is important for cats that are trained to walk onto it otherwise, scales like the Salter one linked above may tip.  This would scare the cat and harm the scale.

All of my cats lost weight during the three months that it took to switch them to canned but none of them became too thin. They slimmed down to a nice lean body weight – losing fat while maintaining their muscle mass.  They also became much more active.

If your cat is overweight, please see the feline obesity article.

Resign yourself to the fact that you will be very frustrated at times and you will be wasting canned food as they turn up their nose at it.  Also, you may want to immediately switch your cat to a dry food that has fewer calories from carbohydrates than most dry foods. Talk to your veterinarian about specific brands.

The low-carb dry foods are very high in fat and therefore are very calorie dense.  These foods must be portion-controlled, otherwise your cat may end up gaining weight.  Let’s presume that a certain dry food has 612 calories per cup.  One quarter of a cup contains 153 calories so be very careful to pay attention to how much of these high calorie dry foods you feed.

The caloric needs of an average cat can range between 150 to 250 calories/day depending on their lean body weight and activity level.

The low-carb dry foods are also very high in phosphorus.  This is especially detrimental for cats with compromised kidney function.

And, of course, these low-carb dry foods are water-depleted – just like all dry foods – putting your cat at risk for serious urinary tract problems.  They are also cooked at high temperatures in order to dry them out.

I do not recommend these dry foods for long-term feeding for all of the reasons stated above. Please use them only as transition diets.

Be sure to stay away from any “light” varieties since those types of foods are very high in carbohydrates.

Here are some various tricks for the stubborn ones.

Keep in mind that different tricks work on different cats:

1. If your cat has been eating dry food on a free-choice basis, take up the food and establish a schedule of 2 to 3 times per day feedings.  I really do prefer just twice-daily feedings when trying to transition them.  A normal, healthy hunger response after 12 hours goes a long way to convince them to try something new.
   
2. If you want to take the transition very slowly, you can feed the amount that your cat normally consumes in a 24 hour period – split up into two feedings to get him used to meal feeding.  Many people, however, are unsure as to how much their free-fed cat really eats so I would start off by figuring out the calories that your cat needs to maintain his weight if he does not need to lose any weight.
   
3. Leave the dry food down for 20 minutes, and then remove any uneaten portion.  Repeat in 8 to 12 hours depending on if you are feeding two or three times per day.  During the first few days of transitioning to a set schedule, you can offer canned food during the dry food meals, or in-between meals.  The stubborn ones, however, will not touch it. Do not despair – all cats will eventually eat canned food if their caregiver is determined, methodical, and patient enough.  Once your cat is on a schedule, you will notice that he is more enthusiastic about food during his proper mealtimes and will be much more inclined to try something new. 
   
4. Again, most cats only need 150 to 250 calories/day. The dry food bag should tell you how many calories are in a cup of food but if it does not, you can call the company.      
   
5. Once the cat has transitioned to canned food, I prefer to either free-feed them (if they are not too fat) or to put out a meal 3 to 4 times per day. Small cats in the wild eat 8 to 10 small meals per day. I do not worry about leaving canned food out for up to 12 hours at a time. Keep in mind that a lion is not going to eat his entire prey immediately.
   
6. Once you have established scheduled mealtimes, you will most likely need to start feeding a bit less at each mealtime in order to get the normal sensation of hunger to work in your favor.  Again, we are trying to use the normal sensation of hunger to help us out.  We are not trying to starve the cat into the diet change.       
   
7. Once your cat is on a schedule of meal-feeding instead of free-feeding, try feeding a meal of canned food only. If he will not eat it – and the very stubborn ones won’t, try not to get frustrated – and do not put down dry food.  Try some of the other tips listed below.  If he still will not eat the canned food, let him get a bit hungrier.  Offer the canned again in a couple of hours, or just leave it out.  Some cats will be more apt to try something new if they keep walking by it and seeing/smelling it.  Try a different brand/flavor or a different ‘trick.’  Once it has been about 18 hours since he has eaten anything, give him just a small amount (1/4 of a cup) of his dry food – keeping track of his daily caloric intake.
   
8. Remember to be patient.      
    
9. Exercising your cat with a tassel toy before feeding can also help stimulate his appetite.  
        
10. Cats’ noses are much more sensitive than ours are.  They can smell the dry food in the cupboards.  I suggest either putting it in the refrigerator or putting it in a tightly sealed container.  If they can smell it, they will hold out for it.  Some people recommend getting it out of your house completely, but this is not possible when you are dealing with a very stubborn cat that needs a bit of time and patience to make the transition happen. 
         
11. The following worked for my cats:  Sprinkle a very small amount of tuna – or any other favorite treat (some cats do not like fish and would prefer cooked chicken) – on top of the canned food and then once they are eating this, start pressing it into the top of the new food. (The “light” tuna is better than the fancy white tuna because it has a stronger smell.  Or, Trader Joe’s makes a Cat Tuna that is very stinky.)  Be careful to decrease the amount of fish as soon as possible.  Health problems can occur with a predominantly fish-based diet.  Plus, you do not want to create a situation where your cat will only eat very fishy foods.   
       
12. Make sure that any refrigerated canned food is warmed up a bit.  Cats prefer their food at ‘mouse body temperature.
    
13. Try offering some cooked (or raw – whole meats, rinsed well or partially baked) chicken or meat baby food.  One of the goals is to get your cat used to eating food that does not crunch.  He needs to get used to a different texture.  Also, chicken is a great source of protein to point him in the proper direction toward a high protein, low carbohydrate diet. If he eats the chicken, he may head right into eating canned food.  Then again….he may not.
    
14. Try sprinkling some parmesan cheese on the canned food.  Most cats love parmesan cheese and this trick has been very successful for me.
    
15. Try a product called FortiFlora, feline version. Most cats LOVE FortiFlora and this has recently become my favorite trick.  This is a probiotic made by Purina but you are not going to use it for its probiotic properties. You are just going to use it as a flavor enhancer. The base ingredient in FortiFlora is animal digest – the very substance that makes dry food so very enticing to cats. The directions say to use one package per day – and you can use this much if you want to – but this amount is not usually necessary.  You may only need about 1/4 of a package, or much less, with part mixed into the food and part sprinkled on top of the food just as you would use salt and pepper on your own food.
    
16. FortiFlora can be purchased online but an easier product to find is Temptations treats.  I trap a lot of feral cats for spaying/neutering purposes and this is one of the best baits that I can use. These tasty treats can be found at most pet stores.  Put a few in a plastic baggie and crush them with a hammer.  Use the crushed treats as described for the FortiFlora above.
    
17. There are numerous freeze dried meat treats on the market that you can also sprinkle on top of the canned food.  Halo’s Liv A Littles is a popular choice.
    
18. Speaking of texture, a common question is “can I just soak the dry food in water?”  I hedge more than just a bit at this question.  Dry food often has a very high bacterial content.  Mold is also often found in dry food.  Both organisms flourish in moist environments. There have been many deaths of dogs and cats secondary to eating mold mycotoxins, vomitoxins and aflatoxins that often contaminate the grains found in dry food.  If you want to try the trick of wetting down the dry food to alter the texture, please leave it out for only 20-30 minutes then discard it.       
    
19. Try dipping some dry food pieces in the juice from the canned food. Some cats may refuse to eat it if the dry food even touches the canned food.  But if he will eat it with a bit of canned juice on it, try the ‘chip and dip’ trick.  Scoop up a tiny bit of canned food onto the piece of dry food. Put them on a separate plate from his small portion of dry food.  Some cats will eat their small portion of dry and then go investigate the dry food with a tiny bit of canned on it.
    
20. Going one step further, try adding a few small pieces of the canned food to the small portion of dry food.  Your cat may pick around the canned food but will get used to the smell – and texture – even if he does not eat any pieces of the new food.
    
21. Crush some dry food and sprinkle it on the top of the canned food.
    
22. If you do not think it will upset your cat, try gently rubbing a bit of canned food or juice on the cat’s gums  This may get him interested in the taste and texture of the new food – but do it gently.  You do not want to make this a stressful situation and create a food aversion.  (This trick is commonly used to get just-weaned kittens used to eating canned food.
    
23. If you do not think it will upset your cat, use your finger to put a tiny bit of canned food or juice on his paw for him to lick off.  This has not worked for me in the two cats I have tried it on, but it is another idea.  Make sure you do it without stressing your cat.  Again, you do not want to create a food aversion. 
          
24. If you have a multiple cat household, some cats like to eat alone in a less stressful environment, so you may need to take these cats into a separate, quiet room to think about the error of their ways – their carbohydrate/dry food addiction. Once in a quiet setting, away from the other cats, two of my cats would eat canned food/tuna ‘meatballs’ by hand.  Not from a bowl, mind you, but only from my hand. I’m not sure who was being trained. They did eventually start eating from a bowl after a few hand feedings.
    
25. Try various brands and flavors of canned foods.  Try Friskies, 9-Lives, Fancy Feast, etc.  Many cats prefer the foods that are all by-products and turn their noses up when offered the by-product-free diets like Wellness, etc. You can worry about feeding a a different canned food later if you want to and you can always mix different types of food together.  The initial goal is just to get your cat used to eating canned food and not dry kibble.  And remember what I said above. I would much rather see a cat eating a canned food like Friskies, 9-Lives, or Fancy Feast rather than any dry food.
    
26. Syringe-feeding is also another option but has to be done with finesse and patience so as to avoid a food aversion.  If you choose to syringe-feed, your goal is not to feed him a full meal.  Sometimes just syringing a 1-2 cc’s can ‘jump-start’ your cat into eating the canned food – maybe not the first time but it will at least get him to taste the new food and experience a foreign texture. The best way to syringe-feed is to kneel on the floor with your cat between your legs so he is facing the same way as you are.  Then, using a small (1cc/TB) syringe, slip it in the side of his mouth and give about 1/2 cc at a time.  He may spit it out but you are just trying to get him used to the taste and texture, not stress him.
    
27. Few canned foods will make it through the tip of a syringe but human meat baby food works well for this trick. You can also water it down a bit if you need to.
    
28. If you want to use canned cat food instead of baby food, you will need to cut the end off of the syringe so that the opening is as big as the barrel.  Make sure that the tip is smooth.  If you do not want to cut the tip of the syringe off, you will need to puree a pate (versus chunks) type of food.  I puree Wellness for this.  I run it through the blender with a small amount of water (about 3-4 tablespoons/5.5 ounce can).  Then I strain it to remove anything big enough to clog the small tip of the syringe.  Wellness is also a balanced diet, unlike human baby food.
    
29. Even though human baby food is not a balanced diet for long-term use, it is a great tool that can be used to help transition a cat to a texture that he is not used to.     
     
30. I did have to take drastic measures for a foster cat named Molly.  She was dangerously obese (20 lbs – double what she should have weighed) and would not eat canned food even after two weeks of syringe-feeding her.  She needed to go in for a dental so while she was under general anesthesia, I put in a feeding tube. This took the stress off of both of us.  After two weeks of feeding her via the tube she started licking the canned food from my fingers then suddenly decided it was time to eat it.  She then started to finally lose weight.  Before the 7-pound weight loss, she could barely walk, could not clean herself, and was quite possibly headed for diabetes.
    
31. Don’t give up.  One of my barn cats ate dry food for the first 12 years of her life.  She would never touch the canned food that the other cats ate. Then, one day, she found her ‘inner carnivore’ and started eating canned food out of the blue!  I was shocked.  That was 4 years ago and she has been on a 100 percent canned food diet since she made the switch.

These are just a few tricks that you can try.  Different tricks work on different cats.  The key is to be patient.  Remember, it took me three months to get my cats on 100 percent canned food.  Most cats, however, will not take this long.

Cytauxzoon felis infection is highly seasonal and takes place in spring and early summer when the tick population is active.

What is Cytauxzoon felis?

Cytauxzoon (pronounced “sight-oz-o-un”) organisms are blood parasites that were first recognized in Africa as a parasite of antelopes and other ruminants. Cytauxzoon organisms were not discovered in the U.S. until 1976, when Cytauxzoon felis was first described as a feline blood parasite affecting and killing cats from forested areas.  Initially, there was concern that livestock were soon to be next as this was a ruminant infection as far as anyone knew, but research showed only cats could be infected. It appears that in the U.S., the natural host of this infection is the bobcat, where most of the time, the infection is minor, and it is only the domestic cat for whom infection is a disaster.

Cytauxzoon felis is a single-celled organism that infects both the blood and tissues of the cat. The blood cell stage of the parasite called a piroplasm, is not particularly harmful; it is the tissue stage, called a schizont, that is the problem. The schizont infects immune cells that line blood vessels, which causes them to swell and block off the blood vessels in which they reside. Any tissue that has blood vessels (which is basically every tissue in the body) can be affected, but most symptoms seem to relate to the resulting red blood cell destruction and inflammation. Symptoms start small with listlessness and fever but quickly progress to jaundice, spleen enlargement, pain, and death within one week with a two to three-week incubation period from the time of initial infection.

How do Cats get this Infection?‘

The organisms are home to the immune cells lining the blood vessels as described above, and if the host lives long enough, the schizonts will eventually produce offspring (the piroplasms). Bobcats do not get sick during this process. It is the local bobcat population that infects the local tick population.

Cats cannot be infected without a tick bite.

How is the Diagnosis Made?

The cat typically has a fever, with or without jaundice, and is brought to the veterinarian for evaluation. In most cases, the piroplasms are fairly obvious when the blood sample is evaluated. Because the tissue phase of the infection with the schizonts comes first and the blood infection with piroplasms comes after, it is possible that at the time the blood is tested no piroplasms are yet present. Because of the rapid progression of the infection, piroplasms will likely be seen in a few days if they are not at first, so sometimes a second blood evaluation is needed.

Because piroplasms sometimes have variable sizes, they are sometimes mistaken for Mycoplasma hemofelis, a much more treatable infection.

Cytauxzoon organisms are larger and have a thick “dot” on their ring shape.

If the diagnosis is to be made post-mortem (after death), it is usually easy to find the schizonts in many body tissues.

A milder strain of Cytauxzoon felis seems to have emerged in west Arkansas and east Oklahoma, where a number of cats have survived without treatment (as do most bobcats). These cats continue to have piroplasms in their blood but seem to have no effect from this. It is yet unknown how this is able to happen. (Different strains of Cytauxzoon, effective medication, and genetics are all theories.)

Prevention

Since mortality is quite high with this infection and treatment is still highly investigational, prevention is paramount. The most effective prevention is to keep the cat indoors where there is no tick exposure. The next best prevention is to use a tick control product on the cat; note that there are not nearly as many tick products for cats as there are for dogs. Most canine tick products are toxic to cats and cannot be safely used so meticulous label reading is crucial. Just because a product works on fleas definitely does not mean it also works on ticks and the feline label is needed to ensure safety. New products are being approved and released every year, so ask your veterinarian.

Besides the haired parts of the skin, these tumors can be seen at the lip margins, the eyelids, the anus/rectum, the vulva, and the prepuce of the penis (the fold of skin covering the penis). A specific, poorly understood form of cutaneous lymphoma seems to occur near the hock, which is the ankle of a back leg. A cat can also have skin tumors and lymphoma elsewhere in the body at the same time; often it’s seen in the lymph nodes, gastrointestinal tract, liver, spleen, kidneys, mouth, or nasal passages. As with non-cutaneous lymphoma in cats, each case is different.

The disease is complex and there are several forms of it. Unfortunately, there is no overall consensus from the veterinary community on what the best course of action is in any individual cat.

The cause is unknown in most cases. Feline leukemia virus and feline immunodeficiency virus can cause lymphoma in cats, but don’t seem to be involved in most cases of cutaneous lymphoma. Lymphoma in cats can rarely happen at a vaccine site, but most vaccine-associated tumors are other kinds of cancer, not lymphoma.

Cutaneous lymphoma can look like skin nodules, masses, ulcers, or just areas of skin that are flaky, bald, or changed in color. Some of the skin tumors can be large.  As time goes on, the skin often becomes thick, red, ulcerated, and may ooze fluid. Cats can also have signs of internal disease such as swollen lymph nodes, a lack of appetite, weight loss, vomiting, diarrhea, and general weakness.

For diagnosis, a piece of tissue is taken from the skin tumor, usually with either a biopsy or a fine needle aspirate. It is examined under the microscope. Cutaneous lymphoma can look like some other skin diseases, so enough testing must be done to ensure accuracy. Blood tests and a urinalysis may be needed. More tests like X-rays, ultrasound, or tissue samples may be used to see if other organs besides the skin are involved.

Treatment is much like other cancers. Surgery can sometimes remove skin masses or lesions. This surgery can be useful to get tissue to make the diagnosis. If the cat is lucky and the lymphoma is ONLY at one place on the skin, surgery may also help for treatment, but this situation is rare. It’s much more common for lymphoma to involve lots of different organs at once. Even if only the skin is affected, there are usually too many sites for surgery to help.

Chemotherapy is the main form of treatment for that reason as it can help multiple areas of the body at once. If all goes well, it can be really effective at reducing the lesions even in a short time, although this result may not last. Radiation may occasionally be helpful for skin lesions occurring in just one spot. Rarely, cases with lymphoma in multiple spots on the skin have also been treated with a superficial form of radiation that treats the skin without affecting deeper organs. Corticosteroids pills such as prednisolone are often part of chemotherapy for cutaneous lymphoma. If the corticosteroids are used by themselves when more effective therapy isn’t an option, they may give some temporary relief.

Sadly, there is no cure and the long-term prognosis is poor. However, chemotherapy can slow progression and temporarily improve a cat’s quality of life. On average, cats treated for cutaneous lymphoma will only survive for less than a year. Some cats live longer, though, and cats whose disease starts out at only one spot might be likely to do better.

Diseases associated with the liver, gallbladder, and/or bile duct system can be confusing for pet owners because these diseases can have really vague symptoms. It’s not always clear why they happen, and the terminology used to describe them tends to sound like a foreign language. Cholangitis/cholangiohepatitis, the second most common type of liver disease seen in cats, is a prime example. This disease is sometimes referred to as cholangitis, sometimes cholangiohepatitis, and sometimes cholangitis/cholangiohepatitis syndrome. In addition to these names, several different forms of the disease exist, which all have their own names. To add to the confusion, sometimes other diseases can occur at the same time as cholangitis/cholangiohepatitis, which makes figuring out the cause for the symptoms and diagnosing the problem pretty difficult. 

Helpful Definitions

Cholangitis means inflammation of the biliary tree (also called the biliary tract or bile duct system), which connects the gallbladder and liver and helps these organs make, process, store, and secrete bile. Bile is used to break down fat from food in the intestines. Cholangiohepatitis means inflammation of the biliary tree as well as the surrounding liver cells. Cholangitis/cholangiohepatitis can be caused by bacterial infection, in which case the disease may be called neutrophilic cholangitis. It can also be caused by a parasite known as a liver fluke, which causes inflammation after it invades the liver. Another type is called lymphocytic cholangitis. It is associated with lymphocytes, a type of white blood cell involved with the immune system, and it likely occurs because of an overreaction by the immune system.

Pancreatitis, or inflammation of the pancreas, and inflammatory bowel disease, an immune-mediated condition associated with inflammation, poor digestion, and poor absorption of nutrients within the gastrointestinal tract are common conditions that occur in cats that develop cholangitis/cholangiohepatitis. Veterinary scientists don’t know exactly why these diseases happen together, but over 50% of cats have one or both of these diseases in addition to cholangitis/cholangiohepatitis. 

Clinical Signs and Symptoms

Depending on what type of cholangitis/cholangiohepatitis a cat has, the symptoms may occur slowly, over a long period of time (chronic) or happen suddenly (acute). Common signs include poor appetite, throwing up, diarrhea, acting tired, drinking and urinating a lot, fever, weight loss, belly pain, swollen belly, and a yellow tinge (jaundice) to the skin, gums, and eyes may be seen.

Diagnosing Cholangitis/Cholangiohepatitis

Lab tests will be run on the cat’s blood to see how the red blood cells, white blood cells, and platelets are handling the disease. This type of test is called a complete blood count or CBC. A chemistry lab test will also be run, which will show the disease’s effects on the liver as well as other organs. Findings that point towards cholangitis/cholangiohepatitis include high liver enzymes. Increased levels of bilirubin, which is a product of the breakdown of red blood cells by the liver, can also be seen. At high levels, bilirubin can cause jaundice (yellow-tinged skin, eyes, and gums). Other tests include abdominal x-rays and ultrasound to examine the liver, gallbladder, and biliary tree. Ultrasound can also be used to sample the bile to check for and culture bacteria. Finally, to officially diagnose cholangitis/cholangiohepatitis, biopsies of the liver tissue are needed. These can occasionally be done with abdominal ultrasound, but often surgery is needed to get large enough pieces of diseased tissues for a pathologist to properly examine. 

Treatment

Treatment may depend on the cause or reason for the cholangitis/cholangiohepatitis (e.g. immune-mediated vs. bacterial infection). If the cat has pancreatitis or inflammatory bowel disease, those will require treatment as well. Antibiotics are commonly used although they may be switched to different kinds depending on the bile culture results. Antibiotics are usually needed for at least 1-2 months and should be continued even once the pet starts feeling better. Steroids to suppress the immune system may be needed. Supplements or medications to help support the liver and biliary tree may also be prescribed, including ursodiol, vitamin E, and SAMe. Do not start any supplements without consulting your vet.

In addition to medications, very sick cats may need hospitalization, IV fluids, a feeding tube, and/or surgery to remove the gallbladder. Surgery is usually only needed if an obstruction or blockage occurs within the biliary tree/bile ducts. Prognosis, or chance for improvement, varies depending on the cause. Cats with acute neutrophilic cholangitis, which is a sudden onset bacterial infection of the biliary tree, usually recover. Those with chronic or long-term forms, or lymphocytic forms of cholangitis, tend to respond poorly to medications and the disease can worsen over time to the point of liver failure. 

If you suspect your cat has a form of cholangitis/cholangiohepatitis, or you have questions about the disease, call your veterinarian for further information. 

A cat with cerebellar hypoplasia is abnormal from infancy, though it may not be clear that something is wrong until the kittens are toddling around with some coordination. The cat with this disease clearly has balance issues: he walks with his legs widely placed for fear of falling and places his feet clumsily. He often leans against walls for support. Sitting still, he may look like a fairly normal cat but once focused on a toy, food bowl, or friendly hand, tremors begin and get more severe as concentration becomes more intense. Still, despite the obvious impairment, cats with this condition are happy, able to feed themselves and use a litter box, and are felt to have good life quality.

Your Cerebellum and You

Certainly, the decision to move from point A to point B is voluntary but the chances are you can walk across pretty uneven terrain without falling down or even thinking about where to put your feet. You can thank your cerebellum for that.

Your cerebellum receives information from your feet as well as from the vestibular apparatus in your middle ear. This information tells you where up and down are and where your body is in relation to up and down. Your cerebellum integrates all this information so that you can not only walk or run across uneven terrain without devoting any conscious thought to how to do so, you can turn your head, maybe even drink from a bottle of water, and look at another person while you are walking without (much) chance of falling down.

Your Cat’s Cerebellum and the Feline Distemper Virus

The mother cat may not be actually infected during pregnancy to create this syndrome; if while pregnant she has been vaccinated with a modified live distemper vaccine, the most basic of all cat vaccines, it can have the same detrimental effects.

.Kittens infected with distemper under age 2 weeks may also experience enough cerebellar damage to suffer cerebellar hypoplasia. This means that mother cats due for vaccines should not be vaccinated during pregnancy or in the first 2 weeks following kitten delivery.

Diagnosis

While imaging such as CT scanning or MRI can be used to confirm the underdeveloped tiny cerebellum, the diagnosis of this condition is usually obvious because of the following features:

• The condition is non-progressive (it doesn’t get worse).
• The cat is not weak, he’s just not coordinated.
• Intention tremors are evident when the cat is focused but the cat looks largely normal if still.
• Walking is uncoordinated with a wide stance, often using the wall for support.

Treatment

No treatment can resolve the damage in a kitten with cerebellar hypoplasia. Some kittens are more severely affected than others. Owning a cat with cerebellar hypoplasia emphasizes managing the condition. The cat should be indoors only and non-spill food dishes should be obtained. Most cats have good life quality and make-up in personality what they lack in motor skills.

Prevention

This syndrome is easily prevented by vaccinating female cats for feline distemper when they are neither pregnant nor nursing kittens under age 2 weeks. This means that regular vaccination will prevent cerebellar hypoplasia in kittens. If a cat is pregnant, vaccination should be withheld during pregnancy and for a good three to four weeks after the kittens are born. 

Pathophysiology

Infection with Blastomyces occurs when a cat or dog inhales the fungal spores into the lungs. The incubation period is from 5 to 12 weeks. Some animals don’t show clinical signs for a long time after being infected, but those animals are not contagious to other animals and people. Blastomycosis organisms have a predilection for the respiratory tract, and pulmonary disease is the most common sign (88-94% of canine cases). Once the lung disease develops, yeast forms of the organism spread throughout the body. Organs typically affected include eyes, bones, skin, lymph nodes, subcutaneous tissues, brain, and testes. It can also be found in the nose, prostate, liver, mammary glands, and heart, but those locations are less common.

Dogs appear to be much more susceptible to infection than other species. Although the disease does occur in both people and cats, the incidence is much lower than in dogs. Dogs are ten times more likely to contract the disease than are people, and 100 times more likely than are cats. The incubation period in dogs is also shorter than in people. The reason dogs are more susceptible is unknown, but immune-deficiency may play a role. Annual prevalence in dogs in endemic areas is estimated at 1-2%. Many infected animals live within 0.25 mile of water. An increased number of cases can occur after periods of unusually heavy rainfall. Historically, young (i.e. 1-5 years), male, large-breed (e.g. hounds, pointers) dogs have had the highest risk of infection. (This is probably because these animals would tend to have more contact, due to hunting activities, with the organism’s geographical area.) However, any age, breed, or sex of dog can be infected.

Clinical Signs

The signs of illness will depend on what organs are infected. Some dogs will have eye problems, and some will have neurological signs (seizures, head tilt, etc.). Lameness may occur, if the infection is in the bones. Owners of dogs in the specific geographic areas should watch for coughing, difficulty breathing, eye inflammation, enlarged testicles, fever, swollen lymph nodes, ulcerated/draining skin lesions, bloody urine, difficulty urinating, nasal cavity signs (including bloody nasal discharge), and lack of appetite. (Weight loss occurs because of the decreased appetite.) Infections in the nasal passages may result in skull damage, and lead to infection of the brain. Large skin abscesses and neurologic signs are more common in cats than in dogs, while bone lesions are more common in dogs than in cats. Hypercalcemia can occur in dogs, although it’s rare in cats and non-domestic feline species.

Diagnosis

Diagnosis involves physical exam, blood tests, imaging (radiography, ultrasonography, CT, etc.), urinalysis to look for Blastomyces yeast, cultures, serology, and biopsies of affected organs. Fungal serology, to look for antibodies, is not always accurate and has been known to produce false negatives. The enzyme immunoassay (EIA) for B. dermatitidis galactomannan antigen appears to have a high sensitivity in urine (93.5%) and serum (87%). The EIA assay is commercially available; cross reactions with Histoplasma capsulatum, Coccidioides immitis, and Penicillium marneffei can occur with this assay. The definitive diagnosis is finding the fungus in the tissues.

Treatment

Treatment involves various antifungal medications, including itraconazole, ketoconazole, fluconazole, amphotericin B, and some combination therapies. These medications usually need to be taken for a long period of time; how long depends on the specific case. Treatment usually can be done at home, unless the disease is severe. Pets with respiratory involvement should be on restricted activity. In severely ill dogs, intravenous fluids, oxygen, antibiotics for secondary infections, and pain medication may be necessary. Skin lesions may require wound cleaning and debridement.

Eyes that are severely affected may not respond well to the treatment because the medication does not penetrate eyes very well. Ocular blastomycosis cases may need systemic and topical corticosteroid therapy, topical anti-glaucoma medications, etc. Significantly affected eyes may require enucleation (removal of the eyeball).

Pets with severe lung disease may get worse at the beginning of treatment because the fungal organisms are dying; the mass death of organisms can cause severe respiratory problems.

Patients may not appear to improve for one to two weeks after the start of treatment. Close monitoring should be done for the first two weeks, and then rechecks are usually scheduled on a monthly basis. Rechecks may involve blood tests, biochemistry profiles, and imaging, if appropriate.

Prognosis

The prognosis for many pets is good, especially if owners can afford to treat the pet for long enough. Approximately 50% to 75% of affected dogs recover when treated with itraconazole, fluconazole, or an amphotericin-ketoconazole combination. Prognosis is poor for dogs with severely affected lungs, but if the dog survives the first 7 to 10 days of therapy, the prognosis improves. However, mortality rates in dogs with Blastomyces dermatitidis can be as high as 41%.

The prognosis for the retention of vision, in animals that have eye disease, is variable.

Dogs with brain involvement often die. Seizures are common upon death of the organism and may be uncontrollable.

Prognosis is also poor when at least 3 body systems are involved.

Relapses are most likely to occur in dogs that had a severe case at onset, or dogs that were not treated long enough. Relapses are most common within the first 6 months after treatment. Dogs that recover from the disease are probably not immune to getting it again.

After discontinuing therapy, animals may be rechecked at 1, 3, and 6 months for evidence of relapse. In one study, relapse rates for itraconazole and fluconazole were 18% and 22%, respectively. Relapses are treated like a new infection.

There is no way to prevent your pets’ exposure to Blastomyces other than by keeping them away from affected geographic areas.

Zoonotic Potential

Blastomycosis is not considered to be a zoonotic disease. It is acquired by humans via inhalation or direct contact with infective conidia/spores. Risk of infection is higher for excavation workers, and for people working or playing in wooded areas with waterways. Blastomycosis cannot be spread between dogs and other animals, or between dogs and people. However, immunocompromised people should limit their contact with infected pets and should wear gloves when cleaning and treating draining lesions.

The Human Disease

Infection with Bartonella henselae in an immunocompetent person (i.e., a normal, healthy person) person leads to cat scratch disease. The inoculation site, a scratch from a claw containing bits of flea dirt, develops a small red bump called a papule. About 2 to 3 weeks following contact with the infected cat, the lymph node in the area will swell and become painful, and a fever will develop. These signs generally resolve on their own, and the condition is minor, though lymph node enlargement can persist for several months.

If the patient does not have a competent immune system (in other words, they are very old, very young, debilitated from another condition, etc.), one of several far more serious syndromes can result. The infection goes deeper into the body and causes spleen enlargement, and potentially encephalitis, heart valve infection, and other conditions. These syndromes are rare, but they are potentially quite serious.

How Likely Is It for a Cat To Be Infected?

Since fleas carry the bacteria, cats with insufficient flea control are at the highest risk. This means cats living in climates that are warm and humid (conditions where fleas thrive best) are most likely to be infected. If conditions are right, up to 40% of cats in an area may be infected. If a person is diagnosed with cat scratch disease, there is a 90% chance that the cats they own will be found infected as well.

This sounds somewhat concerning for the cat-owners in a flea area but it is important to realize that an infected cat cannot transmit the infection without a claw full of flea dirt. If the fleas are removed from the infected cat, there will be no flea dirt in the coat and no risk of disease transmission. Experimental studies have not been able to demonstrate cat-to-cat transmission in cats that mutually groom each other, fight with each other, mate with each other, or share food or litter with each other, nor has transmission been demonstrated between infected mother cats and their kittens. Short of an actual blood transfusion from an infected cat, fleas or ticks are needed to spread the infection.

Do Infected Cats Get Sick?

This is a highly controversial question. It was only relatively recently discovered (1992) that cats themselves were more than simple carriers of Bartonella henselae and that they could actually become actively infected themselves.

Several illnesses seem to have been associated with Bartonella infection (fever, deep eye inflammation, lymph node enlargement, muscle pain, reproductive failure, and bacterial heart valve deposits called endocarditis), but these seem to be isolated cases for the most part. The Bartonella organisms are highly adapted to live in the feline body without causing disease, and it is only in rare situations that cats actually experience issues from this infection.

It has been suggested that Bartonella infection may be at the root of numerous chronic inflammatory conditions of the cat. With such high numbers of infected cats occurring regionally (up to 40%), it is going to be difficult to prove one way or the other whether there is a real association or just coincidence.

Can Dogs Get Infected?

The short answer is yes, though the species they get is Bartonella vinsonii rather than Bartonella henslae. Fleas may carry the infection as they do for cats, plus it appears that ticks may also be carriers. Since there are numerous infectious agents spread by ticks and it is not unusual for a dog to have multiple tick-borne infections, it is difficult to determine which infection is causing which signs.

Is My Cat Infected?

Testing is not recommended for the average cat, even if the cat is sick. Testing would be a good idea for any cat that may become a blood donor, for the rare sick cat where Bartonella-related disease is actually being considered if a human in the home has been diagnosed with a Bartonella-related disease, or if there is an immune-compromised person in the home, in which case testing is actually important.

There are five tests available to detect Bartonella henselae: ELISA, IFA, PCR, Culture, and Western Blot. All the tests have pros and cons, and no method seems to shine above the others.

The ELISA, IFA, and Western Blot tests are tests for antibody detection, the idea being that if antibodies against Bartonella are there, then Bartonella must be there as well. For most diseases where antibody levels are used to establish a diagnosis, a minimum titer or antibody amount is considered necessary to say “Yes, this patient is infected.”  A problem with this is that we know that up to 11 percent of cats with Bartonella organisms happily circulating in their bloodstreams will not make antibodies and will thus test negative. At least this means that when the test is negative, there is an 89 percent or greater chance that the cat is truly negative. For screening, this kind of antibody testing is frequently paired with PCR testing.

PCR is a very sensitive DNA test for Bartonella, but because the organism only intermittently circulates, false negatives can result if not very much Bartonella DNA is circulating. Results from PCR testing can rapidly distinguish different species of Bartonella. 

The most reliable test is the blood culture; however, several consecutive cultures are needed because the organism tends to circulate only intermittently. A positive culture is proof of infection, though a negative culture may simply not have been taken at the time when the organism is circulating. 

In humans, a delayed hypersensitivity skin test is used as part of the diagnostic criteria for cat scratch disease but this test has not been useful in cats. In this test, similar to the tuberculosis test most of us are familiar with, a scratch on the skin is made, and a reaction to the introduced antigens may occur either right away or in approximately 48 hours (delayed hypersensitivity reaction). Cats are poor delayed hypersensitivity responders. 

All in all, it is hard to rule out a cat as a carrier of a Bartonella organism. If the results of testing are suggestive of infection, treatment can be considered if the cat is truly believed to have an illness from the infection or if there is realistic concern about exposure to an immune-compromised person.

Treatment for Cats

An assortment of antibiotics have been used against Bartonella henselae in cats: clavulanic acid-amoxicillin combination, azithromycin, doxycycline, and quinolone class medications (enrofloxacin, marbofloxacin, etc). Efficacy has been mixed, and Bartonella henselae rapidly becomes resistant to therapy. Treatment is currently recommended for cats showing symptoms of disease or for cats living with immune-compromised individuals.  Treatment lasts a minimum of three weeks.

Preventing Human Infection of Bartonella: Guidelines from the Centers for Disease Control and Prevention

• Cats belonging to immune-compromised people should be kept indoors only and should not have contact with cats that go outdoors.
• Claws should be kept trimmed.
• Cat scratches should be promptly washed. (This goes for everyone, not just immune-compromised people.)
• Flea control should be strict. 

Preventing Disease

No data support chemoprophylaxis (i.e., preventive drug treatment) for Bartonella-associated disease. In simpler terms, if a suspicious cat scratch has occurred, there is no point in using medication to prevent infection.

 The same is true with many other substances, like water, that need to be regulated. Urine is (usually) sterile, so unless there is a urinary tract infection, urine is pure. It’s not the terrible stuff that many third graders make it out to be. True, it does have the waste products of metabolism in it, which a body needs to remove.

And that’s where some of the problems begin. If the flow of urine stops, those waste products build up and negatively impact the way the body works. One of the most common ways that happens is when a cat’s urethra (the tube that carries urine from the bladder to the litter box) gets blocked. Known in veterinary parlance as a ‘blocked cat’ or ‘blocked tom,’ this poorly understood disorder is seen with alarming frequency in veterinary hospitals and ERs.

Many ERs see about two to three cats per week who cannot urinate. Cats can be in all stages of the disease, from the early onset ones who just seem a little painful and have a big, hard bladder to the nearly dead ones that are in many cases beyond saving.

The actual plug that stops the flow can be made of bladder stones (often erroneously called kidney stones), tumors or a gooey mix of mucus and protein known as ‘matrix’ that has the consistency of toothpaste. How and why matrix forms, no one knows, despite a few decades of investigation. Adding to the confusion, the name of the disorder has changed no less than four times in the past 20 years from feline lower urinary tract disorder (FLUTD) to feline urologic disorder (FUS) to feline interstitial cystitis (FIC) to the most recent iteration of Pandora Syndrome, which hasn’t really caught on yet.

The causes go beyond a mucousy plug, as well. A host of other factors, such as stress, lack of access to water, diet, infectious agents, indoor lifestyle, and many other causes have been implicated as being responsible for the lead-up to getting blocked. Those little plugs don’t form in a vacuum: something causes them to form, and we don’t know with any certainty what factors contribute to it.

Cats that are blocked often show the following signs:

1. Straining repeatedly in the litter box (often mistaken for constipation)
2. Crying or howling
3. Licking at the genitals/below the base of the tail
4. Hiding

If you notice your cat showing any of the above signs, get right in to see your veterinarian or go to your nearest ER as soon as possible. Don’t delay as a few hours can make a big difference. The longer those toxins circulate unchecked, the more pain the cat experiences, the more work the veterinarian has to do, and the bigger the final bill will be.

In advanced cases, where the urine flow has been stopped for more than 24 hours, cats can become systemically ill from retained toxins and start vomiting, or become very weak and lethargic. Death usually happens within 48 hours, and it’s not a pleasant way to go. The pain with this disease is immense, and some cat owners understandably choose euthanasia over trying to reestablish the flow of urine.

The course after unblocking these cats is just as unpredictable and mysterious as the factors leading up to the obstruction; some cats are released from the hospital never to suffer another episode, while others will have repeated occurrences days, weeks or years later. This is an inhumane disease.

Managing these cases medically can go way beyond relieving the obstruction in some cases. First priority is fixing the plumbing problem: getting urine to flow. This is usually done with anesthesia and a catheter to remove the obstruction. Managing the havoc wreaked by the toxins is next. This can necessitate some medical dancing as veterinarians try to put things back in place. Disorders of deadly potassium, elevated renal values, and severe dehydration can mean days in the hospital, even long after the urine is flowing again. It can get complex, expensive, and can wear down even the most committed of owners for the really medically complex (and expensive) ones.

However, getting the urine to flow and taking the cat home is the easy part. After this episode, lifestyle changes are necessary: medication tweaks, medical rechecks, and diet changes that try to extend the initial complexity of this disease across months or years.

Compared to 20 years ago, cats with this disease do go home and get better, even some of the tough cases.  Someday, science will provide an answer and veterinarians will have some means to prevent this disease in the first place, or some surefire way to treat it. Until then, rush your cat in to be seen if you see the signs.

Conjunctivitis is inflammation of the conjunctiva, a tissue that makes up part of the eye and eyelid. In people, the conjunctiva is the white part. Conjunctivitis is common in cats and can be a result of infection or injury.

The two bacteria species best known to cause conjunctivitis in cats are Chlamydia felis and Mycoplasma spp.

An infection caused by Chlamydia may cause redness, discharge, and excessive tears. Bacterial conjunctivitis caused by Chlamydia is treated with antibiotics. All cats in a household may need to be treated, as some cats who have it do not show any symptoms.

Mycoplasma is a natural inhabitant of every cat’s eye, so infection happens when there is an overgrowth of that bacteria. Treatment for the Mycoplasma infection is similar to that of Chlamydia: antibiotics. The goal in treating Mycoplasma conjunctivitis is to reduce the overgrown number of bacteria back down to a normal level because it is impossible to eliminate them entirely.

Who gets bacterial conjunctivitis?

Both cats and dogs can get conjunctivitis caused by bacteria or viruses. Conjunctivitis is the most common cat eye disease, and most cats will develop the infection once in their life. All breeds can develop infection, and juvenile and young adults are more likely to get it.

Clinical Signs of Either Form

1. Red eyes
2. Eyelid redness
3. Eyelid swelling
4. Excessive blinking
5. Eye discharge
6. Eye crusting
7. Tearing
8. Squinting
9. Scratching the face to relieve irritation

 Diagnosis

A physical exam of the eye by your veterinarian is the first step, as this will rule out other causes of redness, such as trauma.  The easiest diagnosis is a cytology test, which means looking at scrapings of the irritated tissue under a microscope. If a lot of bacterial and inflammatory cells are seen, it is likely that the eye is infected. Checking scrapings is a quick test for infection that can be done at the clinic during your appointment. PCR is another test that can be used to detect the specific organism causing the infection, but typically needs to be sent out to a lab.

Treatment

Antibiotics are used to treat bacterial conjunctivitis, mainly doxycycline.  Mycoplasma and Chlamydia are the most common bacteria involved in eye infections, and doxycycline is effective against both.

Prognosis

Treatment should clear the signs and infection. However, if the eye still looks infected or just doesn’t look normal, contact your veterinarian. The ongoing bacterial infection may also be caused by an unknown factor that needs to be treated before the eye infection can be cured.

Prevention

There is a vaccine for Chlamydophila felis, but it is not required and is usually only suggested if your cat is at a higher risk for an infection or in a multi-cat household. There is no vaccine for a Mycoplasma spp. infection because it is normally in the eye anyway.

The key to preventing infection is separating sick cats away from the unaffected ones and bringing them to your veterinarian at the first sign of infection.

More simply, this means the airways of the lungs are inflamed, plus they are extra reactive to mental stress or respiratory irritants, and the flow of air through the lungs is reduced (either sometimes or all the time). When all three features are present, we can be comfortable diagnosing asthma.

What Exactly is Happening in the Lungs with Asthma? 

First, excess mucus forms in the airways. After that, the airway walls swell with inflammation and can actually ulcerate. Finally, the airway muscles go into spasms leading to constriction. Airway constriction leads to an inability to draw a deep breath, intolerance to exercise, coughing, and musical sighing sounds called “wheezes,” though not all these symptoms may be apparent at the same time.

Is Feline Asthma the Same as Human Asthma?

The feline condition was named asthma because of the clinical features shared with the human disease. As of this time, it appears that all the diagnostic criteria needed to diagnose asthma in people are shared by cats, yet we are still working out the mechanics of this syndrome in cats and have a great deal to learn. For example, in humans, we know that while actual symptoms of asthma occur in episodes, the airways of the lung are diseased all the time. We do not know yet if feline airways are also diseased all the time or if the actual airway structural changes occur only when there are clinical signs of distress.

How is the Diagnosis Made?

Because of the constricted airways, the actual volume of air this patient can move in and out of the lungs with each breath is reduced. There is often a great deal of effort seen in the cat’s breathing. The abdomen appears to be working to push air out and the breaths are shallow and rapid. The cat may even be breathing with its mouth open in an effort to move the largest possible amount of air.

The next step toward making a diagnosis of feline asthma is the chest radiograph, assuming the cat is not in too much distress to hold still for this procedure. Classically, this radiograph will show what is called air-trapping, meaning that the small airways have constricted so that inhaled air cannot be exhaled. The lungs are larger in appearance than normal as they are over-inflated. The diaphragm may seem flattened due to this over-inflation.

It is possible to view the tiny airways in much higher detail on radiographs. This is partly because they are made more prominent because of the mucus and inflammatory fluid inside them (the doughnuts and tramlines, as mentioned below) and partly because they are surrounded by more air than usual (air-trapping).

Inflammation and mucus build up within the airways, causing their walls to appear thickened in the radiograph. The terms used for such airway appearance are doughnuts (when viewing the airway end-on) or tramlines (when viewing the airway from the side). You may hear your veterinarian use these terms, and they are classical findings in airway disease. 

Some Asthmatic Cats Have Normal Radiographs

Since visible changes are not always evident on radiographs, which can lead to diagnosing asthma when it is not there. Indeed, diagnosing asthma can be complicated, and it is famously underdiagnosed because up to 23% of asthmatic cats can have completely normal radiographs.

The coughing cat with normal chest radiographs poses a diagnostic dilemma. It is hard enough to sort out potential issues when there actually are radiographic changes, as many conditions can mimic others. Because of the nature of feline heart disease, where the heart muscle can thicken without the overall external shape of the heart changing, heart disease should be considered. In heartworm-endemic areas, feline heartworm disease should be considered. If the patient is thought not to have too high of an anesthetic risk, a tracheal wash and/or bronchoscopy can be considered but often have indefinite results. CT (cat scan) imaging is emerging as a helpful diagnostic tool, but it is not yet available in many areas.

Response to Therapy as a Diagnostic Test

One important asthma feature is that the airway constriction it engenders is reversible. In an emergency situation, a small dose of epinephrine (adrenalin) or terbutaline (which expands airways) can reverse an asthmatic crisis in as little as 15 minutes. Response to an injectable corticosteroid (such as dexamethasone) generally yields a positive response within 30 minutes.

Sometimes, diagnostic tests still leave room for questions, and you have to simply go with medical treatment for asthma and regard response to therapy as evidence that the diagnosis is correct. See below for a list of medications commonly used in the long-term management of this problem.

Treatment Options

Oral and Injectable Steroids 

It is crucial to realize that the underlying problem in the airway is inflammation. Inflammation is what is responsible for constriction. To resolve inflammation, corticosteroid medications have been the cornerstone of therapy. These can be given in pills, by injection, or, more recently, through a metered dose inhaler. Usually, treatment is started with either an oral corticosteroid such as prednisolone or a long-acting injection such as Depo-Medrol. These medications are relatively inexpensive, and a good response to them helps confirm the diagnosis, as mentioned. A better strategy might be to use oral or injectable steroids to ensure that they work and if they do, change to a metered dose inhaler (see below), as there is much less potential for corticosteroid side effects with an inhaler.

If the response to oral corticosteroids is good, they may be continued long-term, supplemented with some of the other medications mentioned below, or used only during flare-ups. Long-term corticosteroid use has some potential for side effects, though feline patients tend to be resistant to these problems. If giving pills is too difficult, especially in a cat that is stressed and having some trouble breathing, a long-acting corticosteroid injection can be used periodically to control asthma symptoms. Cats are more sensitive to potential side effects from these injections as they are much stronger than oral corticosteroids. This sensitivity means that injections can only be given periodically without the risk of developing diabetes mellitus. If the cat seems to require an injection more frequently than every other month, a metered dose inhaler should be considered (see below for details).

When using oral corticosteroids, it is important to taper the dose over time so as to find the minimum dose needed to control symptoms. If higher doses are used indefinitely, asthma symptoms may become resistant to steroids. This resistance is more of a problem with injectable steroids and manifests as a shorter and shorter interval between the need for the injection. Again, if this is seen, consider changing to an inhaled form of medication.

Metered Dose Inhalers

Human asthmatics have enjoyed the benefits of portable inhalers for years. These handy devices deliver medication locally to the airways, thus minimizing drug side effects to the rest of the body while maximizing desired response.

There were two problems with using these devices in cats:

• Cats cannot be told when to inhale. 
• Cats tend to object strongly to the spray puff delivered by the device.

The discovery that the pediatric spacer could also be used for cats has solved the feline inhaler problem as well. The setup is the same as described above for young children and the cat takes 7 to 10 breaths from the face mask to be properly dosed.

Corticosteroid inhalers, Flovent® being the most popular, are typically used twice daily long term while airway dilator inhalers such as albuterol-containing Proventil® or Ventolin® are used for flare-ups.

Cats are generally started on a combination of oral prednisone and the metered dose inhaler and gradually maintained on only the metered dose inhaler.

Pediatric equipment is generally available from most human pharmacies, however, a device created specifically for feline use can be ordered. It comes with a spacer and an appropriately sized face mask. Your veterinarian will need to prescribe the metered dose inhaler usually from a regular human pharmacy.

See the Aerokat device.

Are there other Treatment Options?

Other medications that might be helpful include:

Allergen-Specific Immunotherapy 

Since allergy is generally a part of the asthma picture, it makes sense that “allergy shots” might be helpful. In fact, they are helpful to many cats. It is important to realize that this form of therapy takes months before benefits are obvious so it is not a method for fast relief but more for the “bigger picture.” The owner must be able to give injections to the patient at home regularly. A veterinary dermatologist is generally needed to oversee this type of therapy.

Airway Dilators

Terbutaline (Brethine®) and theophylline are airway dilators commonly used in the management of asthma. It makes sense that if constriction is an important feature of this disease that eliminating constriction would be therapeutically helpful. Terbutaline is available orally or as an injectable. Some veterinarians encourage owners to keep a bottle of injectable terbutaline at home in case of a crisis and show them how to give it. If you are interested in this, let your veterinarian know. Theophylline is an oral medication usually given once a day at bedtime.

Cyclosporine

The use of cyclosporine in asthma is relatively new. Cyclosporine is an immunomodulator often used in organ transplant patients. It has been used occasionally in cats where adequate suppression of inflammation has not been possible with combinations of the other medications listed or when the cat is unable to take corticosteroids for other reasons (concurrent diabetes mellitus, infection, history of calcium oxalate bladder stones, etc.). Cyclosporine should not be prohibitively expensive since cats, being small, require relatively small doses but blood levels of cyclosporine may be periodically recommended which increases the expense of this treatment significantly.

Don’t Forget…

Minimizing irritants in the air is always helpful to an asthmatic cat.

1. Do not allow cigarette smoke in the cat’s environment.
2. Use dustless cat litter.
3. Consider non-topical insecticides. No sprays, either.
4. Regularly replace air filters at home.

It is important to realize that asthma can culminate in a respiratory crisis that can become life-threatening if ignored. If your cat begins to breathe with an open mouth or if you see excessive abdominal movement during breathing and the cat is not purring, you may have an emergency situation. Contact your veterinarian immediately.

For more details, including a video on the use of the inhaled system, we recommend visiting Fritz the Brave, a website set up by one family devoted to their asthmatic cat. It has grown into a detailed instructional site for both pet owners and veterinarians interested in the details of inhalers for feline asthma treatment.