My Cat Has a Murmur?
What this abnormal cardiac sound means for your cat
Your kitty appears perfectly healthy. You take it in for a routine physical exam and the veterinarian informs you that your precious family member has a murmur. How can this be? What does this mean? He runs around the house, eats like a horse and is borderline heavy on his weight. This is a perfectly healthy cat!
A heart murmur is an abnormal sound that occurs as blood moves through the heart and the valves. Your veterinarian detects it with a stethoscope during examination. Murmurs can be caused by congenital defects, acquired diseases such as hyperthyroidism, high blood pressure, anemia or primary heart muscle or valvular diseases.
Some murmurs occur due to stress or excitement and elevated heart rate. These murmurs are considered benign or innocent and do not cause problems with your kitty’s health.
Studies have shown that as many as 22% of “healthy” cats can have murmurs, unfortunately, the innocent murmurs cannot be differentiated from cats with actual heart disease. In addition, as many as 50% of cats with primary heart muscle disease (cardiomyopathy) that present to the veterinarian in heart failure will not have a murmur prior to presentation.
So, what should you do? Follow your veterinarian’s advice. If your kitty seems anxious at the clinic and the heart rate is elevated, your veterinarian may ask to just recheck your kitty on a different day or ask you to leave your kitty for the day so he/she can become acclimated to the hospital.
Your veterinarian may ask to run tests to rule out diseases outside the heart that can cause murmurs, such as checking blood pressure, a thyroid test or a CBC to screen for anemia. In some cases, a blood test called an NT-pro-BNP may be performed as well. This test looks for stretching or damage to the heart muscle.
If your cat has evidence of elevated or abnormal respiratory sounds, or if the NT-pro-BNP test is abnormal, your veterinarian may request to check thoracic (chest) x-rays or perform a cardiac ultrasound.
If blood testing is abnormal, treatment of the underlying disease can often times eliminate the murmur. If your cat is diagnosed with cardiomyopathy it may be mild and just require monitoring. If disease is more severe medication may be prescribed.
In some cases, no disease will be identified, but most importantly, by following your veterinarian’s advice, you will be armed with information regarding your kitty’s health that allows you to have peace of mind and be pro-active in his/her care for life.
What? The laundry basket isn’t my toilet?
Inappropriate elimination (urinating and/or defecating outside the litter box) is one of the most common behavior issues for which veterinarians are consulted. It also is one of the number one reasons why cats are relinquished by owners to a shelter.
Causes for inappropriate elimination are numerous and include- preference or aversion for certain types of litter boxes, location of the box, and litter substrates. Other causes include litter cleanliness issues, aversion secondary to a painful or stressful event, and inadequate access either caused by physical inabilities or aggressor cats in the household.
Inappropriate elimination should not be confused with urine spraying, though in some cases urine spraying can be present in addition to inappropriate elimination issues.
Initially there may be physical problems associated with the inappropriate elimination; therefore, a urinalysis should be performed in all cases and sometimes fecal testing is required. In some cases blood work to screen for diseases such as kidney disease, diabetes, and hyperthyroidism should be performed.
Once underlying disease is ruled out or addressed, appropriate changes need to be made regarding the environment. These may consist of moving the box to a new location, addition of a new box, removing the hood or any liners, offering a different type of litter, addressing actual care and cleaning of the box, and addressing stressors in the environment such as bully cats, remodeling or other changes to the environment, new animals or people to the household, etc.
In the majority of cases hoods and liners should be removed. Hoods trap odor in the box and also provide limited access in and out of the box which can be perceived as a risk in the multi cat household. Most cats prefer unscented litters and litters that are soft. However, some cats prefer one substrate for urination and a different one for defecation. Clues can be gained by observing what surfaces the cat gravitates towards for urination/defecation within the house.
The box(es) should be scooped at least once daily and the litter should be completely changed and the box washed every week to 2 weeks. The litter boxes should be placed in quiet, less trafficked areas of the house. Laundry rooms (a common location for boxes) are usually noisy and more heavily trafficked so often they are not a good location. A good rule of thumb is one box per cat group plus one – where a group is one or more cats that like each other. So, if there are 3 cats in the house, and only two like each other, there should be 3 boxes. These should be placed in multiple locations throughout the house, on different levels in multi-level houses, and away from food and water sources.
Changes may need to be made in the environment such as adding additional cat trees or vertical spaces for cats to improve social interaction in multi-cat households. Clients may need to experiment with the depth of the litter as well. Older cats often have difficulty with deeper litter due to arthritis and boxes with higher sides can make access difficult.
If there are complex interactions between cats in the household, Feliway diffusers, collars with bells on the aggressor cats, or even medication may be needed.
Your veterinarian will take a thorough history and will usually want a schematic of the house that includes areas where your cat is inappropriately urinating or defecating, where the cat or cats spend most of their time sleeping, and locations of food, water, and the boxes. In addition, a history of care of the box, interactions between cats in the household, and any changes in the environment will be discussed. Medical issues will be ruled out and changes made based on lab findings and history.
Because of the complex and multi-factorial causes surrounding inappropriate elimination these cases can be difficult to diagnose and often require several changes to rectify the situation. The longer the behavior is left unchecked, the more difficult it can be to correct. As always, your veterinarian is the best resource when dealing with inappropriate elimination issues.
The Decision to Euthanize: When is it Time?
This actual scenario played out in my practice today….Chaka, a once stunning Balinese girl was waiting for an exam and blood tests when I arrived at the clinic this morning. Today Chaka looked like a skeleton with matted hair. Her eyes appeared sunken from dehydration and she struggled to breathe. Her Dad, Steve, has always been receptive to all the medical recommendations I’ve made over the years. Sweet Chaka has had more than her share of medical problems, many of which were chronic and required ongoing treatment.
Steve was devoted to her nursing care and follow up visits. Her list of maladies included inflammatory bowel disease that years later transformed into lymphoma (cancer), fatty liver disease treated with a feeding tube, hyperthyroidism and a life-threatening adverse reaction to the drug used to treat the hyperthyroidism. Her last medical crisis happened a year and a half ago. After a blood transfusion and intensive care, we started chemotherapy and much to our amazement, Chaka responded favorably and rallied once again! Steve and Chaka enjoyed another long stretch of blissful feline-human camaraderie.
Today I discovered a heart murmur and a chest full of fluid on x-rays…I quickly called Steve to discuss Chaka’s condition and asked him to come down to the hospital right away. Chaka was looking worse by the moment. My assessment led me to conclude that it was time for the discussion with Steve about sparing Chaka from further suffering. I ran over the options in my mind one more time and reaffirmed that none of the procedures and treatments I could offer for Steve’s approval were likely to lead to good quality time for this kitty. Steve was initially resistant to the idea of euthanasia. He said he wanted Chaka to “go naturally”. I explained that cats do not leave this earth gracefully; that they stubbornly cling to life and can suffer for days. In my opinion it has become our sacred responsibility to make the choice to let go when there is little or no hope for recovery. After all, when felines chose to live inside our homes and we agreed to provide them with safety and food, they ceased to be exposed to predators or severe elements that would have quickly ended their lives when they were sick or weak.
When a terminally ill or aged cat has been under ongoing veterinary care and close monitoring stops eating, chooses to hide in the closet or under your bed, stops using the litter box or no longer seeks affection from the family, it is time to consider euthanasia. In short, the unique daily routine you and your cat have shared has become severely altered. Your veterinarian may still discuss medical procedures and treatments that could prolong kitty’s life. However, the final decision is up to you, the pet parent. It’s best to discuss with family members and friends at what point you will choose euthanasia as the time approaches. Your veterinarian will provide support and counsel through the process. As feline health care givers, we are committed to assisting you with humane end of life care and decision-making
Diarrhea in Cats
Diarrhea is defined as the passing of soft or watery stool (feces). It can be caused by many things including stress, bacteria, viruses, diet, toxins, immune mediated disorders, drugs, and even conditions not directly related to the gastrointestinal tract such as pancreatitis, hyperthyroidism, or adrenal gland disease.
Diarrhea can be acute (sudden onset- lasting a few days to a week) or chronic (lasting more than a few weeks or intermittently over several weeks to months). Frequent small amounts of feces with blood or mucous present are seen with disease in the colon. Larger amounts of feces passed once or twice a day is typical of small intestinal disease. Cats with small intestinal disease often times have weight loss associated with their diarrhea.
Testing for diseases that cause diarrhea can include fecal tests, blood work, and sometimes even radiographs, ultrasound, or biopsy for more chronic cases. Treatment will depend on the cause of the diarrhea.
Since some bacteria and parasites can be transmitted from your cat to you and your family a routine fecal check and de-worming should be performed yearly in accordance with the recommendations from the Center for Disease Control.
If your cat has a bout of diarrhea, seems otherwise healthy and playful, and is current on his/her health care you do not need to be alarmed, but should monitor more closely when scooping the box and make sure that he/she is eating and drinking. If the diarrhea is persisting or your kitty is not eating or drinking well or seems more lethargic, you should call your veterinarian.
Vomiting in Cats: How Much is Normal?
What cat owner doesn’t occasionally come home to a surprise pile of vomit, usually on their best chair or Persian rug?
It is not unusual to see a hairball every so often even when we think we are being diligent about brushing and grooming our cats. Cats shed their hair based upon both increasing daylight hours and warmer temperatures so consequently, indoor cats may shed all year round. For long-haired cats that tend to shed and form mats in their coats, clipping hair from the underside and backside (sanitary clip) can cut down on unpleasant grooming at home. Lion shaves are also recommended to reduce hairballs in long haired cats.
Stress such as a move to a new household, introduction of a new pet, construction or seeing outdoor cats through a window can increase shedding. Most importantly, internal or external parasites (worms or fleas), skin disorders or any illness can cause your cat to excessively lick or groom themselves or to lose more hair than usual. If your cat is vomiting hairballs more frequently than usual, a visit to the vet is important!
For long-haired cats that tend to shed and form mats in their coats, clipping hair from the underside and backside (sanitary clip) can cut down on unpleasant grooming at home. Lion shaves are also recommended to reduce hairballs.
Vomiting dry food eaten too quickly is a common problem because a cat has a very sensitive gag reflex. Try feeding multiple small meals and separating cats that eat quickly in an effort to compete for food.
Vomiting food, brown liquid (bile) or foamy clear fluid (saliva) more than once a week is not normal. A thorough physical exam followed by blood and urine tests will help us detect diseases such as diabetes, kidney disease or hyperthyroidism that could be causing vomiting. Dehydration itself may be life threatening so subcutaneous or intravenous fluids and injections to stop vomiting might be required right away to get a cat through a vomiting crisis. Once the patient is stable, further testing can be done to establish an underlying cause. A feeding trial may be suggested to determine if a food hypersensitivity or allergy is contributing to the problem. X-rays are used to determine whether a foreign object, tumor or obstruction is affecting the stomach or intestines.
If these baseline diagnostic tests don’t lead to a diagnosis and the vomiting persists, ultrasound of the abdomen may give clues as to diseases and samples can sometimes by collected with a tiny needle under ultrasound guidance. A pathologist can then review slides containing the collected cells for diagnostic clues.
Endoscopy is a non-invasive technique for collecting biopsy samples from the stomach and intestinal linings. These tiny tissue samples allow differentiation between an inflammatory process and cancer. A long flexible tube containing fiberoptic bundles is passed into the cats’ mouth under anesthesia and is slowly advanced through the esophagus, stomach and upper small intestine. A flexible tool is passed through a channel in the scope that snips out tiny pieces of tissue while the scope operator is visualizing the site.
At times, the best and most direct way to diagnose a disease of the digestive tract is by doing an exploratory surgery of the abdomen. The advantage is direct visualization of organs and masses as well as a means of collecting good tissue samples for biopsy.
Please schedule an exam if your cat is suffering from vomiting.
Cat Drinking Lots of Water
Do you fill your cat’s water bowl and find that it is mostly ignored? This is normal for many cats, especially cats eating canned food. You will only occasionally see them drink water but it is still important to offer fresh water daily. Cats are desert creatures and their bodies are designed to conserve water. As for yourself: if you drink a lot, your urine is very dilute (pale); if you drink little, your urine becomes more concentrated (dark). The ability to dilute and concentrate urine depends on good kidney function.
A visit to your veterinarian is in order if you find that: you’re filling the water bowl more than you are used to, notice your cat drinking more often and/or find that there’s more urine in the litter box. Common problems that cause cats to drink more water include: diabetes, kidney disease and hyperthyroidism. The good news is that all of these conditions are treatable or controllable, but as with so many medical conditions, early detection generally saves money and leads to better outcomes.
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