Ultrasound or Radiographs (x-rays) – What’s The Difference?
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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.
Let’s Get Specific About Urine
Both human and veterinary doctors who practice internal medicine, consider urine to be “liquid gold”. What is it about urine that makes it so valuable? It is readily available, usually easy to collect, relatively inexpensive to test, and provides a wealth of information. Urine is one of the end products of metabolism (the other is stool).
The composition of urine is a direct reflection a body’s health. A basic urinalysis consists of three parts. The first is a chemical test- the dipstick. Within a minute, a doctor can tell if there is blood, sugar, bilirubin or protein present. A positive test for any of these can mean internal trouble, for example that a cat has become diabetic. The next part is to look at the urine under a microscope. This is important; up to fifty percent of abnormalities may be missed if there is no microscopic exam. The doctor will evaluate: the types of cells present( white or red blood cells,other cells shed from the kidney or bladder), whether there are crystals and if so what kind, and, what kind of casts, if any, show up. Casts are tiny tube-shaped structures made in the kidneys. Different crystals and casts carry different degrees of significance, but may be a clue to what is making a cat ill. For the last part, a test will be done to determine the urine concentration.
The strength of a cat’s urine concentration is measured on a scale called specific gravity. The scale runs from 1.000 (water) to 1.080. If the concentration registers 1.040 or greater, then the cat probably has adequate kidney function regardless of his blood test values.
To understand how a body regulates hydration think of yourself. When you get up in the morning, you usually urinate a small amount of dark strong concentrated urine. There is a small set of cells in your brain that act like a sponge. While you are sleeping and not taking in liquids, the cells begin to “dry up.” They send a message to the kidneys to “close all the floodgates “ to conserve water and minimize urine production. On a hot day or if you are exercising, you drink a lot, and the cells begin”to swell.” Now they send a message to the kidneys “We’re drowning in here; open all the floodgates and make all the urine you can”. As a result, you urinate a large volume of clear dilute urine. The little set of “sponge” cells in the brain almost never fail. However, as a cat ages,the kidneys can fail. They no longer respond to the message sent from the brain. Therefore, the kidneys make urine at a relatively steady rate independent of the patient’s hydration status and brain messages. In order to avoid dehydration, the cat drinks more water to compensate for his increased urine output. In discussing kidney issues, clients often believe that because their cat is producing a good volume of urine, then the kidneys must be working well. In fact it is just the opposite. Therefore, it is important that older cats who can no longer concentrate their urine, have plenty of fresh water available at all times to prevent dehydration. One potentially reversible reason for a cat to have dilute urine is an infection. If the urine sample was sterile, then it will be cultured to see if there is an infection and to identify the proper antibiotics to successfully treat it. In some cases, once the infection is gone, the specific gravity will return to normal.
At the other end of the spectrum, a cat’s ability to concentrate urine can predispose him to bladder problems. Because their ancestors were from desert regions, cats are very good at conserving water. When a cat has healthy kidneys, he does not make much urine and he urinates infrequently- relative to people or dogs. If for some reason, a cat is unhappy, because of environmental stresses ( owners away, rocky relationship with another cat) or issues with the litter box (unclean, wrong litter, location, or size), he may hold his urine for long periods of time. Very concentrated urine sitting in contact with the bladder wall can result in inflammation. Another inflammatory situation occurs when some cats produce an excess amount of crystals in their urine. As they pass lots of crystals with a small amount of liquid urine, their bladder and urethra get irritated. Inflammation is the underlying cause for symptoms of bladder problems including: frequent urination, urination outside the box, bloody urine and straining to urinate. Part of the treatment for these conditions is to make the urine more dilute, that is to lower the specific gravity. Your veterinarian will help you accomplish this when discussing the treatment options.
Urine specific gravity relays not only information about the health of both the upper (kidneys) and lower ( bladder) urinary tract, but also the general internal health of your cat. Just like Goldilocks and porridge, the ideal urine concentration for optimal health is not too high and not too low, but just right.
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.
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.
Litterbox troubles
In all the years he has lived with his people, Bo never failed to use his litterbox. Even when someone forgot to clean it ever day, he would forgive the dirty bathroom and use it as always. Mostly, it was clean and tidy every day. Yesterday was different. Bo urinated next to his litterbox twice. His people were dumbfounded at this new development. They chalked it up to a silly mistake until it happened again this morning. Whatever was Bo thinking?
As it happens, inappropriate elimination, a fancy word for not using the litterbox is one of the most common complaints of cat owners. It needn’t be. By understanding the characteristics of a good bathroom from a cat’s point of view and recognizing that urinating outside of the litterbox may be a subtle sign of a health problem, these frustrating events can be a thing of the past.
The first rule is to presume there is a health reason for the change in behavior. There are many causes, among them:
- Bladder conditions like infection, crystals or stones;
- Kidney disease;
- Arthritis; or
- Any illness causing discomfort or abdominal pain
Consulting with a veterinarian and a good physical examination are the foundation for a plan to address medical concerns that may be at the root of the behavior. If those are ruled out, it is time to examine the environment.
If there are multiple cats in the home, there should be multiple litterboxes in multiple locations. They should be located in a quiet place, scooped daily and cleaned completely once a week. The most popular litter from the cats’ point of view is clay, clumping and unscented.
A change in litterbox compliance may be a sign of stress so a complete history, including any alterations in the household routine should be discussed. Fixing litterbox problems can be challenging but an organized, stepwise approach to a solution is key.
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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