Have you ever participated in a clinical trial? Would you consider having your cat participate in a clinical trial?

Clinical trials are research studies that evaluate how effective a new treatment is by comparing it to standard practice in animals with disease. Clinical trials are often designed based on preliminary data that show that the new treatment may be effective. The clinical trial happens in the last stage of drug development and is an experiment to see if the medication works in real patients with real disease as well as it did in the artificial setting of the laboratory.

Clinical trials offer the benefits of cutting edge research. Conclusions drawn from a clinical trial may go on to benefit animals with similar diseases and oftentimes humans as well.

To be honest, cats have historically been on the short end of the stick when it comes to clinical trials. Pharmaceutical companies have to pay big bucks (millions of dollars) to fund a clinical trial for a new medication that is hoped to be marketed to cats – and if the market is too small (number of cats that will be prescribed the drug), it’s not worth the expense to go through the FDA approval process. Fortunately, that is slowly changing as veterinary medicine and our knowledge of feline disease advances. More pharmaceuticals (drugs) are now being specifically developed and tested for cats. In fact, some pharmaceutical companies have really stepped up to the plate and placed a focus specifically on feline drug development.

You may be surprised to know that many – actually most – of the drugs that we use in feline medicine are actually not approved for use in cats. They may be perfectly safe and even effective when used in cats, but they have never actually been studied and gone through FDA approval for cats (for example, how they are metabolized in cats – we know that cats metabolize drugs very differently from other species, how well they are absorbed etc.). Thus, as we say in the veterinary field, these medications are ‘not specifically labeled for use in cats’. Examples include medications used to treat high blood pressure in cats, many of the insulin types used to treat feline diabetes, medication used to treat heart muscle disease (cardiomyopathy), all classes of pain medication, many antibiotics, most all chemotherapy drugs, most medications used to treat thyroid disease, many ear medications, nausea medication, appetite stimulants, gastrointestinal medications, medications used to treat auto-immune disorders, etc.

Clinical trials may involve a one-time visit to a veterinarian, or they may involve multiple visits over weeks to months. By the time a pharmaceutical (drug) has reached the clinical trial stage, safety studies have been completed – the clinical trial looks primarily at the effectiveness of the drug, though any and all adverse reactions – or even potential adverse reactions – are required to be documented.

How can you find out about clinical trials that might be available for your cat (or you)? Most of the veterinary medical schools are involved with clinical trials (and most will be noted on their websites), and many private veterinary clinics across the country participate in clinical trials (ask your veterinarian). Clinical trials are a great way to be involved with cutting edge research and feline medicine.

Of course, not all cats will qualify for every trial. We had a patient recently, ‘Big Head Todd’ whose owner was very interested in having him enter one of our trials. Big Head Todd is an 18 year old gentleman with a long medical history. He had both of his eyes removed in 2010 due to severe glaucoma that was not responding to medical treatment, he has had hypertension for years – successfully controlled with medication (medication not approved for use in cats of course!), he has arthritis that has stabilized with anti-inflammatories (not approved for use in cats!) and a special diet with added omega fatty acids, and he had one entire ear canal removed surgically in 2011 due to a cancerous tumor in the canal. He’s a happy senior citizen right now. Big Head Todd’s owner noted that his little friend had benefitted so much from kitty research that he was more than willing to have him help ‘pay back’. Unfortunately, Big Head Todd did not qualify for one trial, but he sure has an owner who is dedicated to the advancement of feline medicine – there will likely be another trial!

At my hospital, we have been involved with several clinical trials over the past decade, and we are involved with one currently that addresses hypertension in cats. If your cat – or a cat you know – has kidney disease, did you realize there’s a good chance he or she also suffers from high blood pressure? Right now FREE care may be available for cats that qualify for this exciting clinical trial in which my practice is involved, as are close to 35 veterinary practices across the country (including a few of our felinedocs.com bloggers). Participating cat owners also receive additional incentives. Visit www.mycatcanhelp.com for more information and the ability to search for participating veterinary clinics. You will benefit by receiving free care and other incentives if your cat qualifies – and you will also be playing an important part in the advancement of feline medicine!

How often does this happen to you? You are awakened from a sound sleep by the unmistakable sound of your cat about to cough up a furball on the comforter next to you. If you are lucky, you will be able to move kitty safely to the floor or be resigned to washing the comforter again! Many cat owners think that vomiting hairballs is normal behavior in a cat. But that is not always true. For example, one of my patients is Francis, a 14 year old handsome red and white tabby, who was diagnosed with diabetes several years ago. Up until last year Francis flourished, his weight went back to normal, his appetite was consistently good, and his litter box habits were regular. Then 6 months ago, Francis came in with a few days history of decreased appetite and vomiting. His physical exam was normal; his basic blood tests and urinalysis were normal. A few days later Francis vomited a furball. His owner was happy figuring this was the reason for the symptoms. Over time his weight began to decrease, and he intermittently repeated his pattern of exhibiting a poor appetite and then a few days later vomiting a furball. Additional blood tests and an abdominal ultrasound indicated the possibility of pancreatitis and/ or inflammatory bowel disease as the cause(s) of his symptoms. For now, we are keeping a close eye on Francis. If his condition changes, we will discuss confirming this diagnosis by biopsy and possibly diet changes and medication to treat those diseases.

To his owner, Francis was just having furball trouble. To his doctor, Francis’ furball vomiting was an indication of an underlying problem. Why was I suspicious? A review of Francis’s history indicated that he was vomiting furballs much more frequently than he had in the past. Vomiting furballs more often, particularly in a middle aged or older cat – even as the only change in a cat’s behavior; can be an indication that something is amiss. Either Francis was ingesting more fur because of increased grooming activity – meaning itchy skin (see recent post), or there was a change in the way food was moving through his upper digestive system. There are multiple reasons why this might have happened. Chronic inflammatory disease is the most common explanation. Pain or hormonal changes can also result in alterations in intestinal movement. Just as with Francis, a visit to your veterinarian is a good place to start to rule out an underlying problem.

A few months ago Francis’ owner told me, “ You were right doctor”. What he meant was that he had been skeptical when I had expressed my initial concerns that Francis’ vomiting reflected more than just furballs. Francis’ owner is a loyal reader of this blog. When he was in the other day, he suggested that I write about furballs. He had overheard a comment between cat owners that furball vomiting was routine ( i.e. normal). He now knows that it isn’t necessarily so. He asked that I write about furballs to educate other cat owners about this situation. I am happy to oblige.

This weekend is one of the most sacred holidays in the world – Mother’s Day. Everyone has a mother, and most of us celebrate all the things they’ve done to help us become the people we are. We shop for the card with just the right sentiment, order her favorite flowers, select the age and taste-appropriate candy of cocoa bean origin (milk chocolate is my own mother’s self-admitted favorite food!), or perhaps celebrate her memory with a visit to her resting place. It’s a great time for the free-enterprise economy, too. Florists are busier than accountants in April, and Hallmark heralds May as a month with highest single category sales (greeting cards) than any other month including Christmas (verification withheld to make my point).

So why would we even consider boycotting Mother’s Day? Well, if you’re a cat, since you don’t really care about cards or flowers (though both seem tasty to some cats with intestinal problems), it’s all about the numbers. And while owned pet cats outnumber dogs as pets in the US- 74 million to 70 million according to the American Veterinary Medical Association- there are many cats without homes that are brought to shelters across the country. And more keep coming. There are untold millions of community cats which may or may not be owned or cared for- including being spayed or neutered. Therein lies the problem- left to their own devices, like most other species, cats will reproduce again and again! That may sound shocking to some, and when environmental conditions are favorable, unspayed female cats can have three litters a year! Let’s say those “intact” females have an average of 4 kittens/ litter- that would be twelve more cats from just one in twelve months! If only financial institutions could have such feline fecundity with our funds…

While many shelters are able to find homes for all their healthy adoptable cats, nationwide the numbers don’t balance. Thankfully, many feral cat colonies are cared for by dedicated people who’ve had them spayed and neutered so the colony population stays stable (and healthier!) But in countless communities, because there’s an oversupply and not enough demand (some people have not yet experienced the fun of owning a cat), the all-too-often sad result is that many cats are euthanized.

If you’re a cat, would you rather go home to a family that feeds you, plays with you, cleans your bathrooms and takes you to the veterinarian at least once a year for a checkup, or live “on the streets” like a homeless person, foraging through trash cans and hoping that the soup kitchen is open? That’s why cats boycott Mother’s Day- there’s just no reason to honor having more feline families!

This Sunday I’ll be with my mother! I’ve already sent two Mother’s Day cards and her roses arrived yesterday. I’d still like to get her one more “sweet” gift, though, and I have the perfect one in mind. We’ll take a drive out to the county animal control and check out the cats up for adoption. There’s a good chance we’ll find a beautiful brown tabby with its signature cocoa-colored “M” on her forehead. Maybe I can persuade my mother to call her Lady Godiva…

Almost every day I examine a cat that has areas of hair loss. Sometimes people think that their cat’s hair is falling out. Sometimes people see the cat licking itself or find clumps of hair on the floor. What causes hair loss in cats?

The most common cause is allergies. Cat allergies usually cause itchy skin. Allergic cats can also sneeze or wheeze or have ear infections or diarrhea as well. Cats lick at their itchy skin and because of their raspy tongues are able to break off their fur. This leaves a little stubble on the skin, and often the skin itself is a little pinker than normal. Some cats are “closet lickers” and only overgroom when no one is around.

What can cats be allergic to? The same types of things that bother us – pollens, dust mites, and foods. In particular, cats react to flea bites. When fleas bite, they inject their saliva to keep the blood from clotting. The cat becomes allergic to the saliva and just one bite can make the cat itch to the point of licking or plucking their fur. Many times we can’t even find the fleas because the cat licks so much it swallows the flea (which can transmit tapeworms, another topic).

What do we do to treat allergies in cats? Ideally we allergy test and use desensitizing injections or oral drops. Sometimes we use antihistamines, fatty acid supplements, or hypoallergenic foods. We will almost always use a broad spectrum flea and mite product as well. In severe cases, we will need to use injectable or oral steroids. We now have another medication called cyclosporine, which can also help control itching and overgrooming with fewer potential side effects. There are some anti-anxiety medications that reduce itching as well. In years past we used to think that stress caused overgrooming, but now we know that most of the time the stress is aggravating the allergic disease and making the overgrooming worse.

Other things that can cause hair loss in cats are Demodex mites, fungal infections, and occasionally hormonal problems or cancers. So if your cat’s coat has lost its normal luster or has patches of hair loss it is time for your cat to see your veterinarian!

I was describing “respectful” feline handling to a group of people.  The most common question was, “What?! You are not suppose to scruff cats? That’s how their mother’s disciplined them when they were kittens”

Great place to start.  Mother cats do carry their kitten by the scruff.  They do not discipline them in this manner.

With some cats, this restraining manner can have the opposite desired effect.  There are other more respectful methods and scruffing should be a last resort.  Having your body weight dangled does not make good common sense.

Most of us do not need to restrain their cats at home. Occasionally it is necessary for medical care or nail trimming.  Towels are an excellent method of restraining.  When we use this at the clinic we call it a “purrito.”

There were also questions about how to “punish” a cat for “bad” behavior. Cats on a whole respond better to leaning with positive reinforcement.  Yelling and punishment teach your cat nothing and may be counter productive.

Most of the “bad” cat behaviors that occur at home are normal for cats. Unfortunately the cat’s human companions are not always appreciative of these behaviors.

One of the most important aspects of working with your cat is for you to go outside your human box and think like a cat.  Not easy, but not impossible.  You will be amazed at how more enriched your life and relationship with your cat will become.

Resources:

• More information about handling
• More information on positive reinforcement training

Cats are carnivores and require meat protein. You don’t see cats grazing in the fields as you do with herbivores (non-meat eaters) such as cattle or horses. In the wild, cats that hunt would eat the entire kill, to get their necessary vitamins and minerals. Cats eating 100% muscle meat only are subject to dietary deficiencies such as Rickets (Vitamin D/Calcium deficiency).

But what about grain free – is this necessary? Pet food companies want to make sure that their foods are nutritionally complete and balanced. Ideally, feeding trials have been performed to ensure that the food is complete and balanced. Adding certain grains can boost proteins, add fiber and necessary vitamins and minerals. In addition, grain- free foods are not carbohydrate-free.

• “Jack” was on a grain-free food, but it turned out he had a dietary sensitivity to blueberries and sweet potatoes, components of his grain-free food. Once switched off of the grain-free food, his skin and intestinal issues resolved.
• “Eddie” had urinary problems. Again, grain-free doesn’t mean carbohydrate-free, and it turned out that the carbohydrates in the food he was eating contributed to his urinary blockage problems. Changing his diet has resolved his urinary issues.

So, is grain-free always bad? No. If the food your cat is eating leads to a shiny, soft coat, an alert, comfortable cat of normal body weight, with no abnormal stool, skin or other problems, then the food is fine for your cat. As always, ask your veterinarian about your cat’s diet if you have any questions or concerns.

All the cool cats were smoking the illicit weed during the early days of jazz in the 1920s on the streets of New York City.  In fact, years later, when I was living in Greenwich Village in the 1980s, things hadn’t changed much at all.  The aroma of that fragrant herb would frequently waft up from the street through the open windows of my 4^th floor apartment, strangely reminiscent of…catnip!

Have you ever wondered why cats get so crazy over catnip?  What is it about that herb?

Catnip was originally imported from the Mediterranean, where this member of the mint family grew like a …uh, weed…along the rocky coastline.  The plant’s leaves, stems and flowers are enormously attractive to most cats, including lions, tigers and panthers.  Many of our housecats also love indulging in this lemony, potent mint.

Catnip, which is also known as catmint, is a cousin of basil and oregano.  Even its Latin name, cataria, means “of the cat.”  The allure is from the volatile oils contained in the seeds, leaves and stems, specifically from one chemical in those oils: trans- nepetalactone.  This chemical is very similar to the odor of a female cat in heat, which is why male tomcats are reported to be most affected by the oils.

Genetics determine whether your cat will be intoxicated by this herb and enter that wacky, dreamlike trance.  About 50% of cats inherit sensitivity to the effects of catnip, and all kittens are completely impervious to its effects until they reach about 3 months of age.

Catnip appears to be a dis-inhibitor, which means that a cat’s natural tendencies toward aggression, playfulness or craziness will get magnified.  Some cats will become mellow and calm, and reach a kind of drug high very reminiscent to what happens to humans under the influence of a certain related herb.  Catnip oils induce a narcotic, hallucinogenic state in susceptible cats, as a result of what appears to be stimulation to the cat’s phermonic receptor.

We know cats have an intensely sensitive olfactory system and love to scent-mark and brand their territory through smells.  Catnip seems to enhance that sensation and mimic what happens during a surge of feline pheromones, which are natural compounds that cats use to enhance social communication among individuals.

Cats who are affected by catnip only maintain that bliss state for roughly 10 minutes, and that “high” is triggered by exposure to oils through rolling on the leaves, and licking, chewing and eating the plant.  Once that state is completed, most cats need about two hours to “reset” before they can experience catnip’s hallucinogenic effect again.

Because the trigger is found in the oils of the plant, fresh catnip is most potent, but when the dried herb is tightly-sealed, it can also be appealing.  Interestingly, the herb valerian is a close chemical equivalent to catnip, and will induce a similar response in genetically-susceptible cats.  This herb is commonly found in homeopathic relaxation and anti-stress remedies.

Cats enjoy catnip so much that it’s a relief to know that it is not addictive at all, and it doesn’t appear to be any sort of “gateway” drug that might produce a chronic feline drug offender.  And haven’t you always wondered what catnip might do to people?  After all, cats look so happy when they’re caught up in the ecstasy of the herb!

One of the veterinarians I worked with in a New York City cat practice also was curious.  He told me he raided his cat’s stash one night after work and put some in his pipe and…well, he wasn’t too successful in channeling his feline friends.  He said the end result was a bad taste and one serious headache!

A few weeks ago, one of my clients asked why her cat always wanted to drink from the glass of water she kept by her bed.  She had been doing all kinds of things to keep her cat from doing it, or from drinking from any other water source except the water bowl by the food.  She had read several posts from online forums that said cats are just acting spoiled and being manipulative when they do things like this. She had; unfortunately, found a whole lot of bad information.

So I wanted to share some of the things that I shared with her.  First of all, don’t ever restrict access to water for a cat. As little desert predators, they are hardwired to get their water from their food and they don’t have much of a drive to drink. So when they want to drink, you’d better believe that they need it. And drinking more water is an important indicator of diseases like diabetes, kidney or thyroid disease.  If they don’t get the water, they will get a lot sicker a lot faster.

Dry food is just that, dry.  You’ll see your cat want to drink more water when that is the sole food source. One of the reasons we want cats to eat more canned food is that it will help keep them better hydrated.  And since cats are both predator and prey animals, it’s not in their best interest to sit down to eat or drink out in the open. Cats prefer to drink away from their food for its good ole survival value.  They will, of course drink from bowls next to their food, but if you could ask them their preference, they’d likely say they like that water somewhere else.

Different cats will have different preferences about what kind of water they like, just like we do. I don’t particularly like drinking from plastic. Some cats don’t either. I like fresh water every time. My cats do too. Stale water is pretty yucky. So some cats like fountains, some like glass bowls over plastic, and some like the dripping in the sink. Regardless of the source, make sure that it’s fresh at least every day. And wash it regularly. Sometimes we forget about that.

And then there are those cats that just love to play with water.  Play is really important for the cats that live with us.  Out in the world on their own, initiating hunting behavior is often tied to the drive to play with things that move or sound squeaky. They don’t get much of a chance to “play” like they would outside when they live in our homes.  They have to find other ways to get all those urges out and one of the ways can be playing with water.  You can check out the post, Do we really know what it takes to keep a cat happy?, to learn more about what can help cats flourish in our home environment.

So the take home message is that water is very important to good health and you should spend some time finding out what will encourage your cat to drink and take in water the best. NEVER limit water. NEVER think that you are spoiling your cat by catering to their water preference.  And any change in the way your cat is drinking or urinating needs to be brought up with your vet.

If you missed it read about Cosmo’s Big Adventure

Prior to starting radiation he had to have CT scan to determine the plan where he would receive his radiation therapy.  So, no food after midnight since he would have anesthesia.  Always harder than it sounds with 3 cats.

We were up early and Cosmo was then placed in the carrier.  He has always been good about this and I grateful that we started early in life.  The other 2 are then easily fed. I get a call that all went well.  The CT is sent to Calgary for the radiologist to make the plan. A week later we get a call and they are ready to start at any time.

So now it begins., 18 treatments in total.  18 anesthesias.  Sounds overwhelming.  My main issue would be getting him to the facility in the morning and then getting him in the evening.  With my schedule I do not usually leave until 8 in the evening.  Fortunately, the center can keep him overnight.  I am so grateful since we only have about 2 awake hours together. We will start on a Wednesday and finish on a Friday 2 weeks later.

They do not do treatments on the weekend so on Friday I go get him.  I was told to be prepared that the radiation could burn his neck and he might not be able to eat.  Cosmo is one of those cats that lives to eat.  If he did get burned, he might need a feeding tube.  This would have to be tube directly into his stomach and not his neck due to the location of the treatment.

I get him and am prepared for the worst. Happily I had worried needlessly.  He gets home and goes straight for the food bowl. Same old Cosmo especially after he goes and bugs his sister.  Sunday night it will start all over again.  No food after midnight.

Fortunately the next 2 weeks go very well with no issues.  On his last night, he was given a scarf that he graduated from radiation therapy.  I liked the scarf better than he did, but was so grateful for all the good care he received.

Towards the end of treatment, I spoke with his oncologist.  I learned that cats have far fewer issues with radiation than humans.  I also learned that dogs have much harder time than humans.  We also discussed since we had come this far we might want to consider chemotherapy for Cosmo also.  This would be the last step and would be done 3 weeks apart.  The first one would happen during the last week of treatment.  I decide to go ahead given that we had come this far.  He needed blood work to be sure that he had enough white blood cells.

I will keep you posted on how he handles this part of his adventure.  He seems to be enjoying himself and loves seeing people at the clinic.  At this moment, I am happy with my decision since Cosmo seems to be very happy with it.

If you missed it: Feline Sense and Scents-ability: Hearing (Part 1 of 4)

Cats rarely chew on plants, compared to dogs, because the main draw that plants provide is their sweet sugar content. Cats not only fail to taste sweet things, they also deal with sugars poorly in other ways – among other things, they lack a sugar digestion enzyme that both dogs and people have called “glucokinase” which helps break down sugars inside the cells.

Because cats can’t taste sweets, they don’t really “enjoy” sugary snacks the way we would. The inclusion of carbohydrates in cat food has become a very “hot topic” in feline nutrition – while corn and other carbohydrate sources, blueberries, kelp and cranberries may contain many beneficial nutrients, cats likely do not appreciate the flavor, and in some cases it is not certain how well they digest these ingredients.

Most cats prefer canned diets in which the first several ingredients are meat-based. Canned food is better for cats than dry diets because it contains a high water content (about 80%), which helps maintain a lower urine specific gravity (less “stuff” in the urine), which helps protect the kidneys and can help prevent urinary crystals and stones. Most of the cats that we see at Exclusively Cats Veterinary Hospital who are urinating outside the box and have bladder stones or uncomfortable crystals in their urine are eating a dry-food-only diet.

Something else to note – cats do not like bitter taste any more than people do. If you use baking soda in your litter box as a deodorizer and your cat starts eliminating elsewhere, you might stop adding the baking soda to the box. It is quite bitter in taste, and while cats don’t eat litter, they do groom their paws after using the box, so can associate the bad taste of the baking soda with using the litter!

In 2005, a study was done that discovered the entire cat family is lacking the gene for tasting the flavor “sweet”. They have taste buds in that region of the tongue, but they do not function. Cats do taste salty, sour and bitter. Their favorite tastes are salty and sour. Some cats are drawn to “sweet” foods, but it is likely the fat content vs. the flavor that they like.

Their sense of taste is much duller than ours as well – where a human tongue has over 9,000 taste buds, a cat has only 473! The cat may make up for this lack of taste buds with the small Jacobson’s organ at the front of its mouth – a “vomeronasal” organ which is slightly different than either smell or taste. You can see the ducts leading to this organ in the roof of your cat’s mouth behind the upper incisors. The organ sits right at the front of the mouth and connects to the nasal passages. Snakes, elephants and horses also have this organ, among other animals. Humans, it seems, do not have a working vomeronasal organ. To use it most effectively, the cat passes air over the front of the tongue and then touches the tongue to this sensory organ to deposit pheromone molecules there. You can see your cat using this organ when it wrinkles its lips, opens its mouth and slightly sticks its tongue out when “smelling” an area where it finds an interesting smell.

With 200 million odor-sensitive cells in its nose, compared to a human’s paltry five million, a cat’s sense of smell is much more sensitive than ours. However, they don’t hold a candle to a dog’s smelling ability. Dogs have between 149 million and 300 million receptors. Still, smell is one of a cat’s more important senses. Because smell is so important to cats, a stuffed up nose can be extremely detrimental! If a cat can’t smell his food, he is highly likely to turn his nose up at it. Conversely, a scented litter that we find to be pleasantly fresh-smelling is like drowning in perfume to a cat’s sensitive schnozz.