Tagged with " biopsy"

Furballs

May 16, 2013 by     1 Comment     Posted under: Tips & Advice

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.

Dr Kathleen Keefe Ternes

Dr. Kathleen Keefe Ternes grew up in western Massachusetts. She received an undergraduate degree from Cornell University in 1974; a BS degree in 1978 and a DVM in 1979 from Michigan State University. Dr. Keefe Ternes returned home to New England in April 1980. In 1984, she achieved one of her professional goals by opening The Feline Hospital in Salem, MA. . Dr. Keefe Ternes, a diplomate of the American Board of Veterinary Practitioners (ABVP), initially certified as a companion animal specialist in 1990. She became certified as a feline specialist in 2000 and recertified in 2010. Dr. Keefe Ternes is a member of AAFP, the AVMA, the MVMA, and her local organization, the Veterinary Association of the North Shore (VANS). Her involvement in organized medicine includes having been a past president of VANS and current member of the board of directors. She is also a case reviewer for the ABVP and recently joined the Feline Welfare Committee of the AAFP.

Dr. Keefe Ternes lives in Salem with her husband and two college age daughters. Her two senior cats Toby and Petunia keep her on her toes medically.

The Feline Hospital
81 Webb St
Salem, MA 01970

Phone: 978-744-8020
Email: thefelinehospital@gmail.com

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Ultrasound or Radiographs (x-rays) – What’s The Difference?

Feb 21, 2013 by     No Comments    Posted under: Personal Opinion, Tips & Advice

Unlike radiographs, ultrasound uses sound waves to generate a picture of the internal organs. Ultrasound is completely safe and painless and does not require anesthesia or sedation in most cases.

Ultrasound may be recommended after a physical examination, blood test or x-ray indicates an underlying problem. Ultrasound is commonly used in both veterinary and human medicine for a wide variety of problems, including diseases of the liver, kidneys, bladder, stomach, intestines, pancreas, heart, and other organs. As with people, it can be used safely during pregnancy.

Ultrasound can “see” many things that can’t be seen on x-rays. For example, if there is fluid build-up in the chest or abdomen, the organs can’t be seen clearly on x-ray because fluid and tissue have the same density. However, they appear quite clearly on ultrasound, because we can see through the fluid. In addition, while x-rays are helpful to see the shapes and sizes of the internal organs, ultrasound can get a picture of the internal structure.

If an x-ray shows an enlarged heart, we can’t tell from the x-ray if the walls of the heart are thick with narrowed heart chambers (where the blood flows) or if the walls are thin and weak with big chambers or if there is fluid build-up between the heart and the sac that surrounds it. Ultrasound can readily give us this information, which is critical, as these scenarios represent different types of heart disease, with different prognoses and treatments.

Ultrasound is not effective at seeing through air or bone, so it does not replace x-rays but rather is complementary. In some cases both x-rays and ultrasound are needed in order to get a complete picture of what is going on with a patient.

Ultrasound equipment is specialized and quite expensive, so not all veterinary hospitals have an ultrasound machine. Many hospitals have specialists that come to perform the examinations. Other hospitals refer their patients to a hospital that can provide this level of care. In some cases of complex heart disease, evaluation by a veterinary cardiologist may be needed.

Due to the specialized nature of ultrasonic exam and evaluation, it is critical to have a veterinarian who is experienced in obtaining and reading ultrasound images to perform the examination, and make this information apply to each patient in a meaningful way in terms of prognosis and treatment recommendations.

What happens during an ultrasound?

The hair over the area to be evaluated will be shaved, as hair will interfere with the images. A gel (water soluble and safe) will be applied to the skin to help the sound waves generate a good picture. A transducer (similar in size and shape to a TV remote control) is placed on the patient’s skin and slowly moved around over the area to be examined. The ultrasound is computerized, so it can be used to accurately measure the tissues as needed. In addition, images can be stored electronically.

In order to perform a thorough exam, the patient needs to stay relatively still, though some wiggling is fine. Although some cats may be slightly anxious initially, most relax and remain calm once they realize that nothing painful is happening. For cats that are very anxious, your veterinarian may recommend a sedative.

What should I do to prepare for the ultrasound procedure?

Please do not feed your cat for 8-12 hours prior to the examination. Water is permitted. In the case of an abdominal ultrasound, an empty stomach allows for proper imaging of the area near the stomach. There are some diseases/situations where food should NOT be withheld; contact your veterinarian for specific instructions. If your cat is having an abdominal ultrasound, please try not to let your pet urinate for the 3 hours prior to your appointment. This will help get a better picture of the bladder.

What will the ultrasound tell us?

An ultrasound examination will provide a lot of information about your cat’s health. Together with the internist, we look at information from lab tests, x-rays, examinations and medical history to make medical recommendations.

  • A specific diagnosis: often ultrasound can provide us with a diagnosis (or a reason for your cat’s illness).
  • A Partial diagnosis: While ultrasound shows us the shapes and consistencies of the internal organs, it cannot see microscopic changes. This means that while an ultrasound examination can identify abnormal tissue, including growths, it cannot always determine if the tissue is cancerous or what type of cancer it is. For some patients, this information will affect how they are treated and a biopsy may be recommended. In some cases, this biopsy may be performed as an ultrasound guided needle sample under light anesthesia. In other cases, a surgical biopsy is needed.
  • No Diagnosis/ Disease Exclusion: For some patients, the organ changes are not visible enough to pinpoint the problem. We are able to exclude (or rule out) certain diseases, but are left with a list of possible diseases that are causing your cat’s illness. This can be both relieving and frustrating. We will discuss options for therapies based on the available information and will recommend the best path for additional testing to obtain a diagnosis if indicated and desired.

If you have additional questions about whether ultrasound or x-rays are appropriate for your cat, please contact your veterinarian.

Dr Diana Lafer

Dr. Diana Lafer founded Cats Limited in 1995. She earned her bachelor’s degree in biology from Wesleyan University and her veterinary degree from Cornell University. Dr. Lafer has a cat (Sparky), and a dog (Lucy). She enjoys spending time with her daughters, horseback riding, skiing, hiking, participating in triathlons, and volunteering for the Lakeville Pony Club.

Cats Limited Hospital
1260 New Britain Avenue
West Hartford, CT 06110

Phone: (860) 561-9885
Email: cats@catslimited.com

Website: http://www.catslimited.com/
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Tissue and Fluid Samples: Why Are They Useful in Diagnosing Diseases?

Dec 13, 2012 by     No Comments    Posted under: Tips & Advice

Sampling of tissue and subsequent microscopic evaluation of tissue is described as collecting and interpreting a biopsy.  The preparation and evaluation of tissue is performed by a board certified pathologist.  Biopsies are used to evaluate masses and tumors, either inside the body, mouth or ears or on the external surface of the body (dermal or mammary tumors).  Biopsy samples can also be collected from tissue that is red or hairless or ulcerated as a means of differentiating cancer (neoplasia) from inflammatory, traumatized or infected tissue.

Analysis of fluid or a tissue sample is a diagnostic tool used in conjunction with blood and urine tests and imaging (radiographs, ultrasound, CT Scan or MRI) to narrow down a list of potential diseases in a cat.  Microscopic analysis of cells in fluid is referred to as cytology. Microscopic analysis of tissue (biopsy) is referred to as histopathology.  Samples of fluid are “aspirated” with a needle and tissue can be sampled with a small needle and syringe or by an incision that allows tissue to be collected. Fine needle samples of tissue can be collected with direct visualization if accessible to the eye or via one of the imaging systems mentioned above. When a tumor is removed, the entire mass can be submitted to the pathologist to ensure that all tumor cells were removed.  This is referred to as “checking margins” or making sure that “clean margins” are achieved , i.e. all of the cancer was removed.

Fluid samples are collected via a needle and syringe and often used to differentiate causes of abnormal free fluid accumulation in either the chest or abdomen of a cat.  Protein levels, bacterial isolation and microscopic evaluation of cell types are the usual tests done on fluid.  Some types of cancer will “shed” (exfoliate) cells into fluid and the exact cancer can be identified by microscopic evaluation of those cells. Lymphoma, the most common cancer in cats, usually exfoliates in the chest fluid if there is a lymphoma tumor in front of the heart. Feline Infectious Peritonitis (FIP) is a fatal viral (corona virus) disease that can cause abnormal fluid to accumulate in the chest or abdomen or both. FIP fluid has a characteristic yellow color, often contains a white blood cell type called macrophages and has high protein levels.  Congestive heart failure or non-exfoliating cancers like adenocarcinoma, will cause a clear watery fluid to collect in either the abdomen or chest that is free of cells.  Bacterial infection in the chest or abdomen (peritonitis) contains high levels of white blood cells (neutrophils or pus) called neutrophils and the causative bacteria can often be directly visualized inside the neutrophils or macrophages or may be grown on an agar plate (cultured) from the pus. Fluid extracted from around the brain or spinal cord  (cerebrospinal fluid) can be evaluated for inflammatory or cancer cells.

 

Dr Elyse Kent

Dr. Elyse Kent graduated from Michigan State University College of Veterinary Medicine in 1980 and completed an Internship at West Los Angeles Veterinary Medical Group in 1981.

In her early years in practice, Dr. Kent began to see a need for a separate medical facility just for cats, where fear and stress would be reduced for feline patients. In 1985, in a former home in Santa Monica, Dr. Kent opened the only exclusively feline veterinary clinic in Los Angeles, Westside Hospital for Cats (WHFC). Along with other forward-thinking feline practitioners from across North America, Dr. Kent founded the Academy of Feline Medicine in 1991. Through the efforts of these practitioners, feline medicine and surgery became a certifiable species specialty through the American Board of Veterinary Practitioners (ABVP). Dr. Kent became board certified in Feline Practice in the first group to sit for the Feline exam in 1995. She certified for an additional ten (10) years in 2005. There are now 78 feline specialists in the world. Dr. Kent served as the Feline Regent and Officer on the Council of Regents for 9 years. She is currently the immediate Past President of the ABVP, which certifies all species specialists. She also heads up a task force joining certain efforts of the ABVP with The American Animal Hospital Association (AAHA). She currently serves as a Director on the Executive Board of The American Association of Feline Practitioners.

The present day WHFC facility opened in 2000. It was the fulfillment of a vision for a spacious, delightful, state of the art, full service cat medical center that Dr. Kent had dreamed of and planned for over many years.

Westside Hospital for Cats
2317 Cotner Ave.
Los Angeles, CA 90064

Phone: 310-479-2428

Website: http://www.westsidehospitalforcats.com/
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The Diet That Suddenly Works

Dec 5, 2012 by     4 Comments    Posted under: Tips & Advice

My last blog was about dieting, but a more serious concern is the diet that suddenly starts producing results without having changed your cat’s dietary routine. Diets don’t suddenly start working on their own and you cannot wish those pounds away (or we all might be “svelte”). Basically we are talking about what we call “unexplained weight loss”.

Unexplained weight loss is exactly that. Weight loss without a good (or known) cause. The list of causes of unexplained weight loss is fairly long, however, we can usually narrow it down with a little detective work.

Cats, by nature, are stoic and they will not tell you that they are sick until they have to, so you need to be a detective at home as well. Very often the only sign of illness is weight loss. Your cat will try to tell you that everything is fine, but the scale will tell you otherwise.

Being a veterinary detective, we start with the obvious- diet. Have you changed how and what you are feeding your cat? If so, did this change result in fewer calories fed?

Is your cat choosing to eat less on his/her own? A decreased appetite is not specific to any particular disease, but is important information. Is your cat having difficulty eating? This could indicate and underlying dental problem (although most cats will continue to eat normally in the face of advanced dental disease).

Is your cat having intestinal upset (vomiting and/or diarrhea)? This will interfere with proper digestion of food.

Is your cat drinking and urinating more than usual? This could indicate (most commonly) diabetes or an underlying kidney infection.

Is your cat eating more and/or stealing food, yet losing weight? This can be consistent with an overactive thyroid gland or diabetes.

Is your cat on a regular deworming program? Has your cat had a recent fecal test? Parasites can cause weight loss, however, unless there is an overwhelming infection, they are unlikely to cause a drastic weight loss.

These observations are very important and should be shared with your veterinarian. Your veterinarian will need to perform a comprehensive examination on your feline friend. Very often a comprehensive examination along with a detailed history will help narrow the list of suspected diseases help develop a plan to uncover the problem.

In most cases an internal organ screen (blood and urine test) will be necessary. These screening tests give your veterinarian a lot of information – almost like an internal examination.

In some cases radiographs (x-rays) are needed. One of the causes of unexplained weight loss in seemingly healthy cats includes tumors in the chest. The chest is one area that cannot be palpated (or felt) during the examination because it is protected by the rib cage. Chest tumors can grow to a substantial size before causing obvious outward symptoms. An x-ray is necessary to check for chest tumors.

Once the screening test results are in hand, your veterinarian can either start treatment or discuss what additional testing (if any) is necessary. In most cases, if you have screened the blood, urine and stool and have normal x-rays and have still not found the cause of the weight loss, the next step is an abdominal ultrasound.

Ultrasound is a safe and painless way to evaluate internal organs in more detail. While x-rays show us the shape and position of the internal organs, an ultrasound can give us details of the internal parts of the organs. In cases of unexplained weight loss, we are especially concerned about the intestinal tract (one area where blood tests can’t accurately evaluate). The ultrasound can detect changes in the intestines and other organs and help pinpoint problems. While ultrasound will not always give you an exact diagnosis (a biopsy may be needed for this), it will provide a great deal of information and can help direct treatment, provide a prognosis (an idea of what to expect in the future) and other options to obtain a specific diagnosis.

Sometimes it is hard for cat owners to decide how far to go with testing. If you are unsure if you want to pursue an ultrasound and/or biopsy you need to discuss this with your veterinarian. Ultimately, the decision is yours. Our role as veterinarians is to help you make educated decisions about health care for your cats. Make a list of your questions and your concerns to review in your discussion. The most common question I get is “what will we do differently based on the results?” It isn’t possible to discuss treatments for every possible outcome of the testing, but it’s important to know that the results will be helpful.

So please watch your cat’s weight and be a veterinary detective at home. If your cat experiences unexplained weight loss, gather information and make an appointment with your veterinarian. It is much better for you and your cat if we can detect and treat a disease earlier than if we wait for your cat to show signs of illness. Unsure if your cat’s weight has changed? Most bathroom scales are not accurate enough to detect small changes in weight for cats. Either purchase an infant scale to use at home or call your veterinarian to see if you can bring your cat in to be weighed.

Dr Diana Lafer

Dr. Diana Lafer founded Cats Limited in 1995. She earned her bachelor’s degree in biology from Wesleyan University and her veterinary degree from Cornell University. Dr. Lafer has a cat (Sparky), and a dog (Lucy). She enjoys spending time with her daughters, horseback riding, skiing, hiking, participating in triathlons, and volunteering for the Lakeville Pony Club.

Cats Limited Hospital
1260 New Britain Avenue
West Hartford, CT 06110

Phone: (860) 561-9885
Email: cats@catslimited.com

Website: http://www.catslimited.com/
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Directions: Google | MapQuest | Yahoo!

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