Cats are susceptible to a range of infectious diseases. Fortunately, we are able to immunize against some of these potentially fatal diseases. We can’t make specific recommendations on vaccinations without knowing the lifestyle of your pet. Generally though, many vaccinations will need repeating annually. We send out regular reminders every year through the post or by email. Prior to the vaccination, your cat will be given a full physical examination to check for any health issues. Please note that will not give live vaccinations if your cat is pregnant in case it harms the unborn kittens.
Kitten core vaccinations
For the core (general) vaccines, the first injection will normally be given at 9 weeks of age, followed by the first booster 3 weeks later at 12 weeks of age.
A final dose can be given at 16 weeks of age or later followed by yearly boosters.
Vaccinations available for your cat are:
Panleukopaenia Virus – core vaccine
Feline Herpes Virus 1 – core vaccine
Feline Calicivirus – core vaccine
Chlamydophila felis – Only recommended as part of a control regime in a multiple cat household where infections associated with clinical disease has been confirmed. Also certain countries e.g. Singapore require this vaccine before exporting your cat.
Feline Leukaemia Virus – Cats should be tested for FeLV infection prior to vaccination. Very rare in Hong Kong so we do not routinely vaccinate against this disease.
Rabies – Only required for exporting purposes (pet travel) to certain countries. Can be given as early as 12 weeks of age.
We do not recommend vaccination against Feline Immunodeficiency Virus (FIV) or Feline Infectious Peritonitis (FIP – Feline Coronavirus).
Surgery and your Cat
It is important to withhold food from your cat for 12 hours before the surgery. This is to ensure that there is no food in the stomach which will decrease the likelihood of any food being aspirated into the lungs should they vomit during the induction of general anaesthesia. We may sometimes make more specific recommendations; for example, very young or diabetic animals may need food to be withdrawn for a shorter time period before surgery.
There is no need to withdraw water at home as normally we will stop any water intake for the last few hours before surgery at Acorn hospital.
Normally, your cat should arrive early in the morning and will be admitted by the veterinarian. You will be asked to sign a consent form. This confirms that you are aware of the procedure and agree to it being performed. It also confirms that you are aware of any risks and complications that may develop. It is important that the consent form is signed by an adult and ideally by the registered owner.
You will be required to leave a contact phone number for us to use in the event of an emergency. It is essential that you are available throughout the day for us to be able to contact you immediately should the need arise.
We recommend that you call the hospital in the early afternoon on the day of surgery to confirm a suitable time for discharge. In cases of concern we will phone you upon recovery to let you know your loved pet is safe and well, and may advise keeping your cat in overnight for further observation, intravenous fluids and pain relief.
The discharge appointment after surgery will be with either a trained nurse or the veterinarian.
On the first evening, your cat may be a little quiet or sleepy. You should allow them to rest comfortably and the next day, they should be brighter.
We recommend that you offer some food and water when you get home. It is perfectly normal for them to have a reduced appetite. Occasionally, they may vomit that evening.
You should not bathe your pet until 2 days after the sutures have been removed. Try to keep the wound dry and clean. You can check the wound daily for any excessive signs of bruising, bleeding, discharge, swelling or redness.
It is normal for fur to have been shaved and commonly clipped areas are the site of the wound, the leg (where an IV catheter may have been placed) and the neck (for blood sampling). Don't worry, Tthe fur will grow back over the next couple of months!
Occasionally, your cat may cough for a few days following the anaesthetic due to any irritation by the endotracheal tube in the airway. This should resolve a few days after the surgery.
It is important that you stop licking or biting at the wound as this may damage the skin and pull out the sutures. Elizabethan collars will help to prevent this.
The stitches will normally be removed 10 days after surgery free of charge. Sometimes we may elected to place dissolving sutures that do not require removal, but you will be informed of this.
Please follow our instructions regarding any medication (e.g. pain relief) and when to come back to the hospital for a re-visit. At Acorn, we routinely administer pain relief to all animals undergoing surgery.
You should contact us immediately if:
Your cat vomits repeatedly
Becomes excessively lethargic or weak
The gums appear a lot paler than normal
There is excessive swelling or bleeding from the wound
We anaesthetize animals every day. Modern day anaesthesia is very safe and in the case of our beloved pets, the risk of dying under general anaesthesia is estimated to be less than 1 in every 1000. The advances in anaesthesia have allowed us to perform successful surgeries and procedures on even the most critically ill patients.
At Acorn Veterinary Hospital, we take general anaesthesia very seriously and are proud of our safety record. Unfortunately, there is no “ideal anaesthetic agent” but we use drugs that we are comfortable and experienced with and that we also feel are most appropriate to your individual cat’s needs.
Before any anaesthetic drug is given, we give a full physical examination and discuss with you the health of your animal. The more information we have, the more we can ensure a safer anaesthetic. Sometimes, pets may have undetected problems, which may be identified by blood and urine tests.
A pre-anaesthetic blood test (and urine test) will enable us to determine both the general health of your cat and also the functioning of the internal organs. Many anaesthetic drugs affect the blood flow to the major organs and are also inactivated and removed by the liver and kidneys. This will allow us firstly to decide if your cat is healthy enough to undergo a general anaesthetic and subsequently, which drugs are most suitable for use. We strongly recommend a blood and urine test in all senior animals (over 8 years old) and any that we suspect may not be in full health.
Acorn Veterinary Hospital uses advanced monitoring equipment during any anaesthetic to allow us to closely observe vital signs (such as blood pressure, heart rate, oxygen saturation and respiratory rate). Our staff are trained to determine the depth of anaesthesia by evaluating the animal’s reflexes, muscle tone and the response of vital signs to surgical stimulation. Our close monitoring during anaesthesia allows us early recognition and correction of any problems.
Anaesthetized animals are unable to regulate their body temperature. Following the induction of anaesthesia, the core body temperature will rapidly drop risking hypothermia – which is associated with higher mortality rates and surgical complications (such as infection). At Acorn, we use a new system of forced-air warming to prevent hypothermia.
General anaesthesia generally will decrease the heart rate, blood pressure and respiratory rate. An endotracheal tube (ET tube) is a soft plastic tube that is placed into the windpipe to allow us to administer oxygen (and inhalational drugs if necessary) and to assist and control the breathing if necessary. An ET tube also prevents any stomach contents or foreign materials being inhaled into the airways or lungs.
Intravenous (IV) catheters allow us to have immediate access to the blood stream during an anaesthetic. This allows us to administer any fluids or drugs rapidly during and after surgery. IV fluids are an excellent way to make an anaesthetic safer. Firstly, administering fluids helps to maintain a good blood pressure which ensures good blood flow around the body to the vital organs. IV fluids also assist in the rapid clearance of certain drugs and anaesthetic agents from the body. IV fluids also allow us to correct any dehydration before the surgery and replace any fluid loss during the surgery such from bleeding. Ideally, IV fluids should be used for all animals during an anaesthetic and at Acorn, we particularly recommend their use in sick and senior animals.
We recognise that an anaesthetic is a cause of serious concern to you as the owner, and take every anaesthetic we perform extremely seriously.
De-sexing your Cat
If you are not planning to breed from your pet, it is responsible to de-sex to benefit your cat’s health, welfare and behaviour. Neutering males helps to reduce behavioural problems such as aggression, frustration and territorial marking. We normally recommend de-sexing at 6 months of age. After de-sexing, it is important for your pet to be fed less than before the operation as their metabolic rate will be lower and therefore, it will be easy for them to gain weight.
Female health benefits
De-sexing (spaying) greatly reduces the risk of mammary tumours/cancer and completely eliminates the risk of ovarian and uterine disease (infection and cancer). In addition to this, de-sexing also prevents unwanted pregnancies and persistent vocalisation during seasons, usually at night time!
Male health benefits
Desexing (castration) prevents testicular tumours/cancer as well as prostate problems.Uncastrated males can spray around the flat persistently leading to a highly unpleasant living environment.
Feline Coronavirus/ FIP
Feline coronavirus (FCoV) is a highly contagious intestinal infection that causes few problems in most infected cats. In some cats, however, the intestinal form of the virus mutates and gives rise to feline infectious peritonitis (FIP), a disease that is fatal. Two forms of FIP may occur, wet (or effusive) and dry (or non effusive).
Enteric FCoV is highly contagious via faecal-oral transmission, which means that the virus is swallowed in contaminated materials. Most infected cats will intermittently shed the virus. Eventually most cats stop shedding the virus, although persistent shedding occurs in some. Interestingly, lifelong shedders do not usually develop FIP, and the FIP virus is rarely shed in faeces.
Enteric FCoV may cause no signs or only mild diarrhoea.
FIP usually affects cats younger than 2 years of age and also elderly cats. Signs of the wet form of FIP include fever, pale gums (anaemia), jaundice (yellow discolouration of the skin and whites of the eyes), difficulty breathing, and a distended abdomen. With the dry form of FIP, signs reflect the organ system that is affected. Neurologic signs (such as seizures), eye inflammation (uveitis), and difficulty breathing may be seen. Fever and weight loss are also common with the dry form.
There is no single, definitive laboratory test for FIP. As a result, a number of tests are commonly performed to look for evidence of the disease. Abnormalities may include the following:
Tests for antibodies in the blood can indicate exposure to FCoV, but they are not diagnostic of FIP because they do not distinguish enteric FCoV from FIP. Antibody titres also do not indicate whether faecal shedding of the virus is present.
Histopathologic evaluation of tissue samples is currently the only water tight method of diagnosing FIP.
Since enteric FCoV often causes few signs or only mild, short-lived diarrhoea, specific therapy is often not necessary. No known treatment reduces the chance that FCoV-infected cats will develop FIP.
Treatment for FIP is unrewarding and death will ensue regardless. Supportive care with nutritional supplementation, removal of chest fluid, intravenous fluid therapy, and antibiotics for secondary infections may help prolong and improve the quality of the cat’s life.
Supressing the immune system with steroids and other drugs may benefit a small number of cats by reducing the formation of the FIP antibody-antigen complexes.
Although various treatments have been recommended for FIP, little scientific evidence exists regarding their benefit.
Prognosis for the intestinal form of FCoV is good.
Cats with FIP have an extremely grave long-term prognosis, as the disease is sadly fatal.
A complete blood count may show anaemia.
A blood biochemistry profile may show increased blood proteins, as well as signs of abnormal liver and kidney biochemistry.
Radiographs may show fluid in the chest or abdomen, especially with the wet form of FIP. Radiographs and an abdominal ultrasound may show other abnormalities in the lungs and abdominal organs.
Protein analysis of fluid removed from the chest or abdomen can support the diagnosis of FIP.
Further tests (faecal examination, urinalysis, others) may be recommended to rule out other diseases that cause similar signs.
Diabetes mellitus (DM) is also known as sugar diabetes and arises when the pancreas does not produce enough insulin. Insulin is the hormone which allows the cells in the body to utilize blood sugar (glucose) and as it’s level falls, blood sugar becomes raised, with many adverse side effects.
The most common cause of DM in cats is the destruction of the pancreatic cells responsible for insulin production, the beta cells. This normally results from chronic inflammation of the pancreas (chronic pancreatitis) and is known as Type I DM.
Type II DM, which arises from resistance to insulin developing in the body cells, is unusual in cats
Most common in neutered male cats over 10 years of age
Clinical signs include weight loss, increased drinking and urination (PD/PU) and increased appetite.
Some cats also become lethargic and weak and may walk with their hocks (ankles) on the floor, due to potassium deficiency.
DM is diagnosed when fasting glucose is significantly elevated (hyperglycaemia). Stressed cats can have a transient hyperglycaemia, so repeated blood glucose and the testing of urine for high glucose levels is needed to confirm the disease. Further confirmation can be obtained by testing a longer-lasting sugar in the blood, fructosamine.
Additional tests may be indicated to look for other disease that may accompany DM, such as liver disease, hyperthyroidism and urinary tract infections.
Cats with type II DM or mild Type I may respond to an oral mediaction (glipizide) which lowers blood glucose
Most cats require insulin injections to replace their body insulin deficit. There are different forms of insulin, each with a different duration of action. The most commonly used in cats are
Glargine (Lantus) – used increasingly as the first choice with a lower chance of lowering blood glucose levels to a dangerously low level (hypoglycaemia)
Protamine zinc insulin (PZI)- sometimes preferred as may be effective in some cats given once daily
In addition to insulin, the diet may be changed to a low fat, high fibre diet available by prescription.
Follow Up Care and Monitoring
Diabetic cats can be difficult to monitor at home due to the necessity of regular collection of urine samples, and yet may become stressed and anorexic when hospitalised. As a result each case may be handled differently in a way best for that cat.
Most monitoring is by regular blood samples to check glucose levels in response to the current insulin dose.
Prognosis can be good if the DM can be regulated and stabilised.
Possible complications of DM include ketoacidosis and hypoglycaemic episodes.
Effective communication between vet and owner is vital, and successful treatment requires that the owner learn to give insulin injections and become familiar with the signs of under and overdoseage.
With dedication from vet and owner many diabetic cats live active and happy lives for many years.
Giardia duodenalis is a protozoal parasite (single celled) which can cause acute and chronic gastroenteritis. In both cats and dogs, it is a common cause of both weight loss and diarrhoea in Hong Kong.
Giardia is normally spread by the ingestion of the cysts in contaminated food and water. The cysts are found in infected faeces and are spread by the faecal-oral route. Once inside the body, the cysts will mature into trophozoites (active feeding stage of the parasite) and both cysts and faeces can be passed out in the faeces to infect other animals.
Infected animals can appear to be completely healthy with no symptoms at all. However, infections can lead to intermittent or severe diarrhoea, weight loss, inappetance and occasionally vomiting. Sometime, infection may appear simply as small amounts of blood or mucus in normal stools.
At Acorn, we use a rapid test, which can accurately detect small numbers of Giardia antigens (specific proteins) in the faeces. We also routinely analyse faecal samples visually with a microscope after preparation with zinc sulphate flotation and centrifugation (high speed spinning to separate cysts from faecal matter). This visualization allows us to see any other concurrent infections/parasites such as worms or Coccidial cysts)
Since Giardia can be shed intermittently, we may occasionally ask you to collect faecal samples for 3 days to increase the likelihood of detection of Giardia antigens.
There are many different drugs that we are able to use to treat Giardiasis. Albendazole and fenbendazole are commonly used and very effective against Giardia. Metronidazole is another frequently used medication, especially in humans – however it is less a lot less effective in animals than albendazole. These are just a few of the many drugs available for us to use in Acorn against Giardia.
It is very important to treat all animals in the same household together against Giardia (even if not showing symptoms) to minimize the likelihood of re-infections. It is also necessary to clean the environment thoroughly with an appropriate detergent/bleach to prevent re-exposure to the parasite. Faeces should be removed from the environment as soon as possible after each defaecation.
It is very important to note that Giardia can infect humans so appropriate measures should be adopted to minimize infection such as wearing gloves and washing hands.
Chronic Kidney Failure
Chronic renal failure (CRF) is long-standing kidney damage and dysfunction manifested by dilute urine and build-up of waste products (urea, creatinine, phosphorus) in the body.
The kidneys three main functions are:
It is common in older cats but is also sadly seen in younger cats too.
In many cases the original cause is never found.
Identifiable causes include kidney infections and stones, incomplete recovery from acute renal failure, polycystic kidney disease and certain tumours.
CRF may be detected on routine blood and urine tests prior to the onset of signs and diagnosis at this early stage allows treatments to be initiated that may slow further progression.
Early clinical signs include increased drinking and urination (PD/PU) weight loss and reduced appetite.
In later stages vomiting, dehydration, lethargy and bad (uraemic) breath are seen.
Initially full biochemistry, electrolytes and haematology are performed on a blood sample, looking for build-up of waste products indicating poor renal function.
Urine is tested for protein (lost by the kidneys in CRF) and dilution (determining the ability of the kidneys to concentrate the urine and thereby conserve water)
Additional tests may include urine culture to screen for underlying infection, radiographs and ultrasonography, and blood pressure measurement. In some cases a kidney biopsy may be indicated to rule out the possibility of lymphoma.
Management revolves around supporting the remaining kidney function, reducing the load on them and also treating the cat for the resultant deficiencies.
Currently no treatments are available to reverse CRF, and the goals are to slow progression and treat the clinical signs, thereby maintaining quality of life.
A special diet with less protein and phosphorus is the most effective measure and can double lifespan in CRF cats compared to those still on normal diets.
Control of phosphorus levels in particular are important and if diet alone is not sufficient, phosphorus binders such as aluminium hydroxide can be added to the food.
If chronic dehydration is present regular injections of fluids under the skin (subcutaneous fluids) may help with frequency varying from twice daily to twice weekly, and can be done by the owner at home.
High blood pressure (hypertension) can be controlled with various drugs, as can a raised calcium level.
Potassium supplementation and erythropoietin injections to stimulate red blood cell production may also be needed in some cats
Follow Up Care and Prognosis
Frequency of further tests depends on the severity of the CRF present and can range from monthly in severe cases to every 6 months in early, stable cats.
CRF is a progressive disease but rate of deterioration is highly variable. Whilst lifespan is impossible to predict, cats diagnosed with early CRF have an average lifespan of 3 years whilst those with advanced disease may succumb within weeks.
filtrating toxins (BUN, creatinine and phosphorus) out of the blood into the urine, but saving the nutrients in the blood such as proteins and vitamins
concentrating the urine and thereby preventing dehydration
the production of erythropoetin, a hormone that stimulates red blood cell production
Consequently when renal tissue is damaged, the clinical signs and problems that result are linked to the compromise of these functions.
Feline Immunodeficiency Virus (FIV)
Feline Immunodeficiency Virus (FIV) is similar to HIV in humans, which can eventually lead to AIDS. This virus causes a weakening (suppression) of the immune system in cats, which means that affected cats are less able to protect themselves against secondary infections, caused by agents like bacteria, viruses, fungi and protozoa. Fortunately, this disease is rare in Hong Kong and probably only 1% (or less) of cats are infected with the virus.
FIV is a contagious disease that is normally spread from one cat to another by biting and fighting. Deep bite wounds are the most common form of spreading disease. This helps to explain why intact, aggressive male cats that spend a lot of time outdoors are at a higher risk of catching the virus. FIV can be spread by other means but these are less common. It is worth noting that mother cats cannot infect kittens except in the initial stages of her infection. Also it is very unlikely that cats living together will transmit the virus by casual contact such as grooming, sharing food and water bowls and sleeping together.
Infected cats can appear healthy for several years but eventually, infection will lead to a state of immune suppression – this will lead to an infected cat being unable to protect itself against other infections. The signs of a cat infected with FIV can vary greatly. Depending on which part of the body is affected by secondary (opportunistic) infections, will determine on which signs an infected cat will display.
Early infection will often lead to temporarily swollen lymph nodes and a fever followed by either progressive deterioration or periods of intermittent illness. Once disease develops to cause immunodeficiency, common signs include:
Loss of appetite, fever and poor coat quality.
Inflammation of the mouth and gums (gingivitis and stomatitis).
Recurrent infections of skin (e.g. ringworm), bladder and respiratory tract.
Other conditions can include diseases that affect the eyes, central nervous system (e.g. brain) and development of certain types of cancers.
The simplest test is a rapid test, which we can perform in Acorn, which measures the presence of antibodies in infected cats. Because most cats exposed to FIV, will never completely eliminate the virus, the presence of antibodies confirms that a cat is infected with FIV.
It is worth noting that antibody tests can occasionally cause false positive results so in these cases, it is worth confirming the result with a test using s different format, e,g, Western Blot in available in commercial laboratories.
Also at Acorn, we do not recommend testing kittens under the age of 6 months since mother cats that are infected with FIV can transfer their antibodies to the nursing kittens causing a positive result. Many of these kittens are not actually infected with FIV and will not develop disease. To get a true idea of whether a kitten is infected, it is therefore better to test cats after they are 6 months old to ensure there are no maternal antibodies left to cause a false positive.
It is also possible to get false negative antibody test results. This normally occurs in the very early stage if infection e.g. a few days after being bitten by an infected cat. The reason for this is that it can take 2-3 months for antibodies to develop. Occasionally, in cats that have very advanced disease due to FIV, a false negative result can also occur due to severely weakened immune systems that cannot develop antibodies any longer.
There are other ways to test cats for FIV such as polymerase chain reaction (PCR), which can detect very small amounts of the FIV virus’ genetic material. At present however, PCR tends to not produce very reliable results and we therefore, do not routinely recommend using it to detect infection.
Treatment and management
Firstly, it is worth noting that an infected FIV cat does not need to be isolated from other cats in the household unless they are likely to fight and bite each other.
Lifestyle changes that we often recommend at Acorn are mainly to minimize risk of secondary infections in immuno-compromised cats and include:
Infected cats should be kept indoors to prevent infection to other cats and also to minimize exposure to other infections.
Regular cleaning of food and water bowls, toys, litter trays etc with bleach to minimize secondary infections.
Regular vaccinations (for all cats in household) to prevent risk of secondary infections in FIV+ cats.
Regular parasite control against fleas, mites and worms.
Healthy diet which is balanced and complete (not raw food exposing an infected cat to possibly serious pathogens).
Infected cats should be de-sexed .
Close monitoring for any signs in deterioration of health, e.g. weight loss, infected gums, skin or eyes.
Although some vets recommend using antiviral agents (e.g. interferon) and immune stimulating agents, there is no convincing evidence that any of these treatments are beneficial.
Other treatment options that may be considered are using antioxidants such as superoxide dismutase that may increase the number T-helper cells (lymphocytes) that help to fight infections. Also AZT, which is commonly used in humans with HIV, may help in cases of FIV showing symptoms, such as gingivitis or neurological signs. When using AZT, it is important for us to monitor your cat’s red cell count (as sometimes this drug can depress the numbers of red blood cells).
It is difficult for us to accurately predict how long an infected cat can live with FIV. Many cats can live healthy lives for many years. Once cats begin to become infected with severe secondary infections and begin to lose weight, the expected survival may only be months.
FIV vaccines are available but we do not routinely recommend them at Acorn as they have not been proven to be very effective, will interfere with testing and may possibly lead to side effects.
One last point worth noting is that FIV cannot spread to humans.
Adverse reactions to substances within the diet, known as a food allergy, cause year-round itchy (pruritic) skin, with all the resultant signs that may entail.
Protein sources such as fish, chicken and dairy products are the most common to cause problems, but anything that your cat eats on a regular basis can become an allergen.
Remember that the body develops an allergic response after
repeated exposure to an allergen common in their environment.
It is also worth remembering that most commercial foods contain fish and chicken additives, no matter what flavour is stated on the packaging, and so simply changing brands will not help.
Itchiness is non-seasonal, as your cat eats the allergen all year round, and the degree of itch can be mild to severe.
Itching generally leads to self-trauma, with licking, scratching and chewing leading to areas of hair loss, scabs and secondary infections with bacteria or yeasts. Recurring ear infections are commonly seen due to irritation leading to increased wax production within the ear canals and resultant infection.
It is important to note that many itchy cats will mainly lick as opposed to scratch, and a common clinical sign of pruritis is areas of hair loss from the forelegs, flanks or tummy. This is often symmetrical and well demarcated and sometimes confused for hormonal causes of hair loss.
A small percentage of animals may also develop gastrointestinal signs such as vomiting or diarrhoea.
The only accurate way to diagnose a food allergy is by a strictly controlled food trial
Remember that even a single mouthful of an allergen can lead to a marked reaction, just as with a person with a peanut allergy, so strict adherence is VITAL for the trial to be diagnostic.
In cats with secondary infections and severe pruritis, we will generally treat these concurrently with the trial.
Clinical improvement is suggestive of the diagnosis, but to check, your cat should be challenged with the old diet. An immediate return of itching confirms food allergy.
Food allergy, once diagnosed, is easy to treat, by merely preventing the offending allergen from inclusion in the diet. Relapses in animals that steal the wrong foods are commonly seen.
If your cat can be convinced to eat the correct diet long term then prognosis is excellent.
A novel protein, or proteins commercially broken down (hydrolysed) to an unrecognizable size are fed exclusively.
This is performed by either preparing a home-cooked diet containing a protein your cat has never eaten before and a specially chosen carbohydrate, such as rice, or by feeding a prescription hypoallergenic diet from Acorn. Getting your cat to eat a proper home cooked diet can be more difficult than with dogs, and hence prescription diets are generally recommended.
The food trial is continued for 8-10 weeks, with NO other foods given. No treats,snacks or milk should be given during this period.
This condition is also known as allergic bronchitis, with inflammation of the lower airways, especially the bronchi. The inflammation can result in narrowing of these airways (bronchoconstriction) which can greatly reduce oxygen intake.
There are two forms:
Acute (sudden onset within last 3 months) is associated with reversible inflammatory changes
Chronic (long term with often intermittent episodes) is associated with irreversible airway damage and can lead to emphysema
Acute episodes are triggered by an overactive immune response to irritants within the air, such as mould, smoke or dust, and usually the allergen is never identified.
Most cats are young to middle aged when first affected, and display wheezing and coughing. Often the cat may be normal between episodes
In more seriously affected animals the breathing may become seriously laboured, with panting and blue gums and even collapse.
Many cats require urgent medical attention if severely affected and stabilisation is necessary before even diagnostic tests.
A tentative diagnosis may be reached from history and radiographs are advised to both look for changes in severely affected animals, and to rule out other causes of coughing.
Airway secretions can be examined for the presence of eosinophils, a type of white blood cell elevated in allergies.
Bacterial culture and tests for heartworm are also advised.
Cats in severe respiratory distress require urgent hospitalization for oxygen supplementation, injectable steroids, intravenous fluids for shock, and bronchodilators.
Once the cat is stable, long term management is needed to help reduce recurrences.
Long term therapy may include:
Continuation of steroids with a tapered dose ending in the lowest dose that will control the problem
Cyclosporin in cats that have become resistant to steroids or that require high doses of steroids that may lead to side-effects
Bronchodilators and an antihistamine may also be used
Reduction of irritants, such as cigarette smoke from the environment, may help
Most cats respond well to therapy, but long-term treatment is usually required and the occasional relapse common. If the disease is not controlled, progressive, irreversible lung changes are likely.
Gum Disease (Gingivitis)
The gingiva is the part of the gum surrounding the teeth, and gingivitis is inflammation of this region. It is often seen in association with stomatitis (inflammation of the mouth).
Gingivitis can be very painful and reduced appetite and clawing at the mouth when eating are commonly seen. The cat may appear hungry but unable to eat.
On examination the gum margins may be very red and inflamed, and may spontaneously bleed
Gingivitis can be caused by accumulation of tartar at the base of the teeth, and in time this can lead to gum recession and loss of teeth.
In cats there are however other causes of gingivitis, including viral infections, such as calicivirus and feline immunodeficiency virus, and from the production of toxins as a result of kidney problems.
Perhaps the most common cause of repeated gingivitis in cats is however
lymphoplasmacytic gingivitis/ stomatitis.
This condition receives it’s name from the types of cells present in the inflamed tissue, white blood cell types called lymphocytes and plasma cells
The exact cause of this disease is still not known, but is considered to be an immune disease where the cat’s overactive immune system attacks it’s own gums.
The viruses previously mentioned may act as triggers, and also there is some evidence to suggest diet may play a part.
With lymphoplasmacytic inflammation more aggressive changes, involving the back of the mouth and base of tongue as well as the gums, are common, leading to a generalised stomatitis.
The resultant oral lesions may look similar to other diseases of the mouth such as eosinophilic granuloma (see specific article) or tumours, and to differentiate and also definively diagnose this disease, small biopsy samples are taken and sent for histopathology.
Testing for renal function and possible viral infections is also recommended.
In cats with gingivitis merely secondary to plaque accumulation, dental descaling and polishing, and the extraction of any rotten teeth is indicated. Antibiotics are indicated to prevent bacteria spreading via the blood to other organs. Prognosis is excellent after dental cleaning and extractions.
Cats with underlying renal disease or viral infections should be treated accordingly (see separate articles)
Lymphoplasmacytic gingivitis can be a more difficult condition to treat.
Lymphoplasmacytic gingivitis can be very hard to cure, and treatment is often used to control the disease, and keep relapses to a minimum.
Sadly a proportion of cats do not respond to even the highest doses of immunosuppressive drugs or molar clearance, leading to euthanasia as a result of persistent intractable pain.
Anti-inflammatories, strong pain-killers, and antibiotics to control secondary infections and routinely used.
In more serious cases immunosuppressive doses of drugs may be required to control the inflammation.
Another method of treatment is surgical removal (molar clearance)of all remaining back teeth. Whilst this sounds drastic it can often lead to marked improvement, and the gums quickly harden into bony plates capable of crunching even dried cat food.
Eosinophilic Granuloma Complex
Eosinophilic granuloma complex is the build-up of a type of white blood cell known as an eosinophil within the skin, resulting in nodules of inflammation called granulomas.
The underlying cause is thought to be a type of allergic reaction, where the cat’s immune system is over-reacting to an allergen in the environment.
Various allergens have been put forward as potential causes and include foods, flea bite saliva, inhaled allergens and certain fungal and viral infections.
There are three classic lesion types in this complex
The general appearance is often suggestive, but further testing is usually needed to confirm the diagnosis. The most reliable method is skin biopsy.
It is important to decrease the exposure to any suspected allergens.
Steroids are needed to resolve the lesions, and may be needed for several months before a response is seen. In some cases further immunosuppressive drugs are required.
If the underlying allergy can be found and controlled, response is usually satisfactory, and food and flea allergies are good examples of this.
Any cat with eosinophilic granuloma complex should receive regular effective flea control and a food trial should be implemented.
Unfortunately however, with so many potential allergies in the environment, it can sometimes be very hard, if not impossible, to determine the particular culprit. Also many allergens are impossible to remove from the environment.
As a result, some cats may have recurring episodes of this condition, and consequently will need repeated, or long-term medication.
Eosinophilic granulomas may be round or linear and can affect the chin, legs and paws. They are raised and red, and possibly ulcerated, but are not itchy
Eosinophilic plaques are hairless, raw sores within the skin and are mainly seen on the neck, back, thighs and armpits. They are commonly itchy
Indolent eosinophilic ulcers are pits or erosion, usually on the lips or inside the mouth. They are not usually painful or itchy.
Cystitis in Cats
Bladder inflammation (cystitis) in common in young adult to middle-aged cats and is often termed as feline lower urinary tract disease (FLUTD).
It is not a specific disease and can have various causes.
Bladder infections are not common in cats and account for less than 3% of cases in young animals.
Bladder stones account for about 15% of cases
Structural abnormalities such as cancer and polyps account for fewer than 10%
Behavioural problems account for less than 10%
In more than half of cats with signs of cystitis no underlying cause can be found, and if tests to exclude all other causes are performed and found to be negative, the term
idiopathic cystitis is used.
Common signs include increased frequency of urination, tiny volumes of urine, blood in urine and straining or pain during urination. Often the owner will notice the cat using the litter tray many times.
In male cats there is a risk of obstruction, leading to life-threatening kidney failure if left untreated.
Testing a fresh urine sample is vital, and may show red blood cells, white blood cells or crystals.
Urine may be cultured although, as previously stated, infection is rare.
Lab tests may be advised to check kidney function and other medical conditions such as diabetes.
Radiographs are taken of the abdomen to rule out stones both in the kidneys and the bladder. Some stones may not show up on X-ray due to lack of calcium in their composition, and may require more complicated radiographic contrast procedures, or ultrasound scan in order to be seen. These procedures can also effectively visualise the surface of the bladder wall.
Any cause found such as infection or stones is treated.
If an underlying reason is not found certain general treatments are tried
Follow Up and Prognosis
Because stress plays a large part in idiopathic cystitis, once diagnosis has been made, frequent vet checks may be counterproductive.
However if you suspect your cat of a urinary blockage, or signs of cystitis are severe, then urgent veterinary attention should be sought.
Preventative measures such as increased water intake and environmental enrichment are important.
At least half of affected cats will have recurrences, often exacerbated by stressful incidents. The frequency, severity and duration of signs seem to decrease as the cat gets older.
Diluting the urine by feeding foods with higher water content (canned or moist) and encouraging further drinking with water fountains and continual access to fresh water
Daily cleaning of the litter tray (and multiple trays in multi-cat households) to encourage frequent urination
Enriching environment with toys and active playtime
Medications are reserved for more serious cases
pain medications and muscle relaxants can help
Feline pheromone spray (Feliway) may help in some cats
Anti-inflammatory medications may be tried
When faced with a fracture there are many different factors to consider when it comes to which method of repair to use.
The goal of repair is to stabilize the broken bone for long enough to allow healing to occur. With every fracture there is a race between bone healing and implant failure!
Things to consider in fracture management include
With many road traffic accidents or falls, more immediate life-threatening injuries such as blood or air in the chest need to be addressed first. Once the patient is stabilized (which may take days) fractures can be fixed.
With open infected fractures implants ideally need to be kept away from the site of injury as bacteria will grow on them protected from antibiotics.
Commonly used methods of repair are:
the age of patient (and thereby the rate of healing to be expected)
the patient’s activity levels (and thereby chance of implant loosening or breaking)
degree of displacement of the bone fragments
any concurrent diseases (complicating anaesthesia and recovery)
possible infection in an open fracture where bone has pierced through the skin
other injuries caused by the traumatic incident
Sometimes more than one method will be used in conjunction for extra stability, such as an intramedullary pin and external fixator pins, or an intramedullary pin and plate.
It is normal procedure to recommend cage rest for up to 2 months after surgery, depending on the fracture and mode of fixation.
Generally we will recommend follow-up visits to check on progress 3 days and 2 weeks post surgery, and will usually re X-ray the injury at 6 to 8 weeks to check the bones are healing and the implants are in place.
Some implants will always need removal after the bones have healed, whilst others (such as plates) may be left in, and only removed if causing a problem later in life.
Splinting and bandaging. This is commonly used in young dogs with non-displaced fractures that should heal quickly, and is the least invasive method.
Intramedullary pins placed down the centre of the bone. These are also common and best used in fractures in the middle of the long bones such as the femur, where the pin can take good hold in the bottom section.
External fixators, with pins drilled at right angles through the bone and held in position with one or more bars outside the skin. Despite looking scary, these are actually quite non-invasive and have the advantage of staying away from the actual site of fracture. As a result they are often used in injuries that may have been infected.
Plates and screws. These provide maximum security but require the most surgical exposure to place. They are frequently used in older animals that have slower healing rates, often in conjunction with bone grafts to stimulate healing, and in very unstable injuries. They are also often used in very active or big dogs that may place a lot of strain on the implants.
Common pet poisons
Although there are many different drugs, plants, foods and household agents that can be poisonous to our pets, the ones which can commonly affect our animals are listed below:
Onions – (also to some degree garlic and chives) contain sulfur compounds which can irritate the gut and more seriously damage the red blood cells.
Human medications – be very careful with any medication you may use. For example, acetoaminophen (paracetamol) can be fatal , especially in cats.
Chocolate – Theobromine is found in chocolate and pets can be very sensitive to its effects. In addition to gut upsets, it can lead to abnormal heart rhythms, tremors, seizuring and even death!
Xylitol – this is often found in sugar-free chewing gum, sweets and mouthwashes and is toxic to pets, especially dogs, where it can lead to low blood sugar levels.
Grapes and raisins – These can lead to kidney failure and death in animals (more commonly dogs).
Nuts – especially Macadamia nuts can affect different systems in the body causing intestinal upsets, tremors, depression, weakness and stiffness. Toxicity is more common in dogs.
Lillies – all parts of this plant are toxic to cats and can cause irreversible kidney damage.
Caffeine – is often highly toxic to pets. It can cause similar symptoms as chocolate toxicity.
Alcohol – the effects are depending on the quantity of alcohol but in severe cases, it can lead to laboured breathing and death.
Avocado – contains a toxin called persin which can cause gut upsets. It is a lot more toxic when eaten by small pets or birds.
Marijuana – Effects can last for days causing drowsiness, slow breathing and heartbeat, depression and in severe cases, death.
All household detergents/chemicals, human medication, plants, insecticides, herbicides and rodenticides should be kept well away from pets.
Dermatophytosis is a fungal skin infection of animals that affects the hair and surface of the skin. It is commonly known as ringworm since the lesions often appear ring (round) in shape!
The most common organisms associated with dermatophytosis are Microsporum canis, Trichophyton mentagrophytes and Microsporum gypsum.
All of these organisms (dermatophytes/fungi) are infectious to humans. Animals with a weakened immune system (due to age e.g. young animals, disease or drugs) are more at risk of developing a ringworm infection.
Some animals can be infected as carriers showing no clinical symptoms. Hair loss is the most common sign, which may be present together with crusty scaling, dandruff, redness, increased pigmentation and itchiness.
A definitive diagnosis can be made by a fungal culture. A culture will provide a medium for the fungus to grow, which normally takes 2 weeks. A culture normally involves either brushing the hair with a sterile toothbrush or plucking a small sample of hair form the edge of the lesion. It is important that no antiseptic/antifungal creams or shampoos have been used prior to taking a culture sample.
Wood’s lamp examination can also aid a ringworm diagnosis. Hairs that exhibit a positive apple-green fluorescence under a blue light is considered a positive result for Microsporum canis. It is worth noting that many false negative and positive results can occur with a Wood’s lamp exam.
If the infection is localized, it is common to use just topical therapy such as a cream or shampoo. If the infection is persistent or generalized (affecting many parts of the body), we commonly use antifungal medicine such as griseofulvin, itraconazole or ketoconazole, in addition to shampoos (which minimize environmental contamination). Treatment normally is continued for 1-2 months.
It is also important to isolate affected animals to reduce spreading the fungal infection. Cleaning infected surfaces/areas with bleach and detergents and using a vacuum cleaner to remove all hair that has been shed will help to prevent re-infection.
It is important to remember that humans can also be infected with ringworm, so good hygienic measures such as washing hands will help minimize you getting the disease yourself!
Constipation and Megacolon
Megacolon is the condition where the large intestine (colon) is associated with chronic constipation/obstipation with minimal colonic motility. The colon normally receives the remains of the digested material of food from the small intestine and then absorbs the water from this material before passing the dehydrated matter (faeces) to the rectum and anus to pass out.
If the colon has reduced motility, then the passage of faeces is delayed resulting in even more water being extracted from the faecal matter than usual causing the faeces to become very hard and dry. In addition to the decreased motility of the colon, the very dry faeces make the material even harder to move.
If the condition persists for some time, often the faeces will accumulate causing a large amount of dry material in the colon causing it to increase a lot in size and its walls to stretch. Prolonged stretching of the colonic wall will result in irreversible changes leading to a chronically enlarged colon filled with dried faeces called a megacolon. This is very similar to a balloon that has been blown up beyond a certain size causing it too lose its elasticity and never return to its original small shape.
The most common cause of megacolon is an unrelieved or recurrent constipation. Constipation can be due to a variety of reasons such as dehydration (e.g. secondary to kidney disease), chronic intestinal disease, anal disease or narrowing of the pelvis. A distended colon may lose the normal muscle strength further aggravating the constipation.
Another common cause of megacolon is a loss of normal nerve function within the colonic wall leading to decreased muscle strength. Any of these causes will lead to the same result of a dramatically larger colon blocked with faeces.
Sometimes, the condition can be exacerbated during periods of stress such as introduction of a new animal or absence of the owner.
Affected cats will often exhibit signs of severe constipation, such as straining in the litter box for long periods, passing no or only very small amounts of faeces. Some cats will cry in discomfort. Others may become inappetant and even vomit. Many of these cats are dehydrated.
Physical examination will often reveal dehydration (stiff skin on feeling) and an enlarged colon packed with faeces when feeling the abdomen. X-rays can help assess the severity of the constipation. Blood tests and ultrasound scans may help to reveal any contributing factors or diseases such as kidney disease.
In almost all cases, it is important to correct the dehydration by either subcutaneous or intravenous fluids. Several options are available to treat the megacolon and constipation, which may include:
In very severe cases, where the colon has lost all muscle strength and motion, surgery may be required. The surgical procedure is called a subtotal colectomy and involves removing part of the colon. Although we can perform this surgery at Acorn hospital if necessary, we will often try to avoid it as there are many potential complications involved with this procedure(which can be fatal).
Long term management involves changing the diet. Initially, increased dietary fibre can be helpful but in the latter stages of the disease, a low residue producing diet is preferable as less faeces will be produced meaning less chance of constipation. We also recommend wet diets in preference to dry food, to minimize the likelihood of dehydration. Water fountains and regular subcutaneous fluids can also help to prevent dehydration.
Minimising stress by feeding cats separately in multiple cat households and having separate and regularly cleaned litter trays for each cat can help. Also pheromones such as Feliway may also be beneficial. Megacolon is a chronic condition and it is important to remember that it will often recur.
Drugs to aid the motility of the colon by improving the muscle contractions such as cisapride (not easily available anymore).
Laxatives such as lactulose to help soften the stools.
Micro-enemas in less severe cases, may aid the passage of stools. In more severe cases, general anaesthesia may be required to facilitate giving a warm soapy enema, extraction of the stool and manual breakdown/kneading of the stool.
Lymphoma, or lymphosarcoma, is a common cancer of the white blood cells (lymphocytes) of middle-aged and older cats.
It may affect the skin, eyes, gastrointestinal tract, liver, spleen, lungs or central nervous system and can be aggressive if left untreated. It may however respond favourably to chemotherapy, which may add months or even years to the cat’s life.
There are no known breed or sex predilections and it is not known how it develops. In some cats Feline Leukaemia Virus (FeLV) may play a role but this is an extremely rare infection in Hong Kong.
These vary on the area of body affected but three common forms occur in cats:
Multicentric form affected multiple sites, including the lymph nodes
Mediastinal form, affecting the front of the chest, leading to breathing difficulties
Alimentary form, affecting any part of the stomach or intestines, leading to weight loss, vomiting and diarrhoea. A mass may be felt on abdominal palpation and also liver or spleen may be involved/ enlarged.
Other forms may causes skin lumps, seizures or blindness.
Tests performed depend on affected site but include:
Treatment really depends on the organs involved, but most cases require chemotherapy due to the widespread involvement of the disease.
There are a variety of chemotherapeutic protocols used, consisting of a combination of oral and injectable medications.
Surgery may be indicated in some cases, eg with the alimentary form where a large mass is obstructing the intestine.
Serious discussion is advised with your vet before chemotherapy is embarked upon, in order that you are fully aware of potential costs and problems. If treatment is initiated, it is best to start immediately, even if your cat appears relatively well, as waiting can seriously reduce long-term survival.
The goal of cancer therapy is to achieve long-term remission and good quality of life, but a holistic view should be taken; some cats are not suitable candidates for such intensive treatment.
Prognosis depends on location of the cancer, FeLV status, cell type (B cells are acute and aggressive whilst T cell lymphomas are more low grade and chronic), how the cat tolerates medications, and how quickly the cancer is diagnosed and treatment started.
Remissions of 2 years or more can be achieved in 40% of cats that respond well to chemotherapy.
About 70% of cats will gain at least 6 months of good quality life.
Cats that are not treated will sadly survive only 4-6 weeks after diagnosis.
Lymphoma will always return, and is usually more resistant to medications the second time around.
At Acorn we believe that serious thought and discussion is required between vet and client before the decision as to whether to undergo chemotherapy or not is taken. We always place your pet’s interests first and aim to give an informed and realistic appraisal of prognosis and outcome.
A complete blood count, biochemistry profile, and urinalysis
Fine-needle aspiration of any affected mass or lymph node to examine for cancer cells
Biopsies (larger samples) surgically obtained from masses
Radiographs and ultrasound to examine internal organs for involvement
Bone marrow biopsy if bone marrow involvement is suspected
Specialized testing to determine whether B or T cells are involved