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Conditions

Allergies

What is it?

An allergy is an abnormal immune reaction to an otherwise harmless substance - a pollen, for example - that is termed an allergen. Like all animals, cats can (and do!) suffer from allergies, but unlike humans, most allergic diseases in cats cause skin problems.

What causes it?

A cat's immune system has a number of different modes, or arms. One of these utilises a special kind of antibody called IgE, and a chemical called histamine, to help fight off internal parasites. However, it sometimes make a mistake and overreacts to the wrong things - that's what an allergy is. IgE detects and responds to the presence of a foreign protein, and tells the mast cells to release histamine, which causes itching, swelling and inflammation. This then sensitises the area to IgE even more, so a negative spiral develops.

What cats are at risk?

Any cat may develop an allergy, but they are most commonly diagnosed for the first time in young adults. It's also important to realise that a cat cannot become allergic to something the first time they're exposed to it - it takes a while for their system to develop an excessive response to any new chemical they come into contact with, either natural or artificial.

What are the symptoms?

It depends, of course, on the allergy in question! The most common feline allergic condition is Flea Allergic Dermatitis (FAD), where the cat become sensitive to flea saliva, but there are many, many other possibilities, including responses to pollen, dust mites, food, or washing materials. In cats, we generally recognise three common presentations of allergies. The most common of all is Allergic Dermatitis, or Allergic Skin Disease. This can be caused by any type of allergen (yes, even food allergies!) and mainly causes itching, self trauma, and a thing called Miliary Dermatitis - where small lumps form inside the skin, often with scabs on top. Other possible presentations, however, include Allergic Rhinitis (runny noses and snuffling, often caused by dust or pollen allergies); and Contact Dermatitis, where a specific patch of skin becomes sore and inflamed due to local contact (with, for example, a detergent or washing powder).

How is it diagnosed?

Well, telling that your cat has an allergy is pretty straightforward (inflamed, itchy patches or noses are pretty diagnostic!). However, determining exactly what the cause is can be much harder. We'll usually try to rule out Flea Allergies first, because they're so much more common than other types, by starting a very strict flea control programme, and perhaps using a short term medication (like a steroid) to damp down the itchiness. If that isn't sufficient, we'll investigate other options, either by allergen exclusion (avoid the suspicious substance, for example, changing to a hydrolysed protein diet that cannot cause allergic reactions to rule out a food allergy), or direct testing (with blood tests for IgE levels, and/or skin prick tests for histamine release sensitivity).

How can it be treated or managed?

Allergies in cats can be very challenging to manage effectively. The ideal management technique is to exclude the allergens from the cat's diet and environment that they're sensitive to - for example, excellent and strict flea control in cats with FAD. However, this isn't always practical, so other techniques may also be needed. Immunotherapy (a type of vaccine given to desensitise the immune system) isn't widely used in cats, but there are now labs who can supply the appropriate vaccines; however, drug therapy is often required. Antihistamines are quite variable in how effective they are - some cats respond really well, but for most, it's pretty hit and miss - and often have marked side effects (they are essentially sedatives!). Steroids (as injections, tablets, creams or sprays) are often used, but if used in the long term, the side effects to tend to shorten lifespan. In some very severe allergies, a drug like cyclosporine may be needed to reduce the cat's immune response. In most cases, however, a balanced management programme incorporating multiple different strategies is needed to keep them comfortable.

Can it be prevented?

No - cats will develop allergies when they develop them!

Cat Bite Abscesses

What is it?

A Cat Bite Abscess, or CBA, is a common result of cats fighting. Cats' mouths and claws contain a range of unpleasant bacteria, and when fighting they insert these bugs under the skin of their adversary. As the bacteria grow, they form a pouch of dead and dying tissue, bacteria and white blood cells - pus. This pus-filled pocket is an abscess.

What causes it?

As the name suggests, a CBA is most commonly due to a bite from another cat - because cat teeth are long and pointed, and easily penetrate the skin, leaving bacteria behind. Because the teeth are so sharp, and cats heal so well, often the skin will close over and heal, leaving infection inside. The bacteria attack the local cells, and the immune system fights back, building up pus inside a cavity under the skin.

What cats are at risk?

All cats are potentially at risk if they ever interact with another cat! It's less common in indoor-only cats, who fight less frequently, but only a cat who never meets other cats is safe.

What are the symptoms?

As the abscess grows, it becomes painful, however, the majority of the symptoms are due to the infection. Cats with a CBA are often lethargic, off their food, and may have a temperature. They'll often have increased thirst, and may sometimes vomit as well. The site of the abscess, meanwhile, will be painful, swollen and hot.

Eventually, it will burst, and thick cream, yellow or cream pus, often mixed with blood, will ooze out.

How is it diagnosed?

Clinical examination alone is usually sufficient; then the vet will use a needle or a scalpel blade to lance it, to determine whether there is pus inside.

How can it be treated or managed?

The most important factor in managing a CBA is to drain it - antibiotics alone are unlikely to resolve the abscess, the dead tissue needs to be out. The normal way to achieve this is for the vet to lance the abscess with a large-gauge needle to a scalpel blade, and then wash out the cavity. Normally, once the abscess has burst or been drained, the cat will start to feel better almost immediately; however, it may be appropriate to use painkillers or anti-inflammatories and antibiotics to encourage it to resolve faster.

Can it be prevented?

Only by preventing cats from fighting - and cats who go outside will, occasionally, fight. However, neutering cats will often reduce their aggression and therefore reduce the risk of a fight, and thus a CBA.

Cat Flu

What is it?

"Cat Flu" is a very common condition, causing sneezing, runny noses, sore eyes and similar "flu-like" symptoms in unprotected cats. It is also highly contagious, and easily spreads from cat to cat!

What causes it?

"Cat Flu" isn't actually a single disease - it can in fact be caused by four different disease organisms. The two most common are Feline Herpes Virus (FHV, also known as Feline Rhinotracheitis) and Feline Calicivirus (FCV). The third cause is less common, and is the Bordetella bacterium, the same as causes Kennel Cough in dogs. The final condition is Feline Chlamydia (Chlamydophila felis infection); unlike in most species, this bacterium does not usually cause intestinal upsets or reproductive disease, and rarely causes any symptoms except in combination with another infectious agent.

What cats are at risk?

Any cat can become infected! In general, young kittens, very old, or ill cats are at most risk of severe disease, however. The disease organisms are easily transmitted from cat to cat by droplets in the air (especially from sneezing), and some can remain viable and infective for a prolonged period. Many cats also become carriers for Feline Herpes Virus, as even after the symptoms have apparently resolved, the virus will still be dormant in their bodies (mainly in nerve ganglia). If the cat becomes ill or stressed in future, the virus will reactivate and may cause disease, or be shed to infect other cats. Chlamydia is most common in large colonies of cats, and in these situations, any of the organisms will spread like wildfire through the cat population.

What are the symptoms?

The main symptoms of Cat Flu are common to all four infections - runny nose, sneezing, lethargy, loss of appetite and a fever. In addition, Bordetella and Chlamydia often cause coughing; and both Herpes Virus and Chlamydia both cause sore, runny eyes and sometimes corneal ulcers. Calicivirus can lead to ulceration of the mouth and throat, and may result in severe systemic disease that can even be life-threatening.

How is it diagnosed?

In most cases, the clinical signs are diagnostic, and determining which organism is causing them isn't important. If for any reason it is important to distinguish between them, swabs from the eyes, nose and throat can be taken and sent away to a specialist lab who will grow the bacteria and isolate the viruses.

How can it be treated or managed?

There is no specific treatment for Herpes Virus or Calicivirus infection; however, antibiotics (against secondary infections and/or Bordetella and Chlamydia) are frequently prescribed, along with anti-inflammatory drugs (to reduce the fever and make the cat more comfortable). Sometimes, mucolytic drugs (to soften the mucus in their noses and help them to breathe) may be used as well. In severe infections, intensive care nursing, intravenous fluids and even interferon (to stimulate the immune system) may be needed. In most cases, however, good quality home nursing is more appropriate than hospitalisation. It is important to encourage ill cats to drink (for example, with running water, or by moistening their gums to stimulate thirst) and eat (with a bunged up nose, cats are often reluctant to eat because they can't smell the food - so strong-smelling foods such as fish, warmed, and hand fed, are often the best solution).

Can it be prevented?

Feline Herpes Virus and Calicivirus can both be prevented by vaccination, and are present in the normal annual boosters your cat should get. Although vaccination doesn't always stop the cat from carrying the viruses, it does mean that it is very unlikely for them to develop disease, or spread them. It is possible to vaccinate against Chlamydia, but this isn't normally necessary except in very large colonies of cats.

FeLV

What is it?

FeLV is Feline Leukaemia Virus, a retrovirus of cats that attacks their immune system. Although in some ways FeLV is similar to FIV ("Feline AIDS"), they are in fact completely different viruses.

What causes it?

The FeLV virus is relatively common in unvaccinated cats (perhaps as many as 8% of cats carrying it). When a cat is infected (by bites, shared feed bowls, litter trays or even mutual grooming), the virus starts to attack the white blood cells. The cat's immune system will usually stop this rapid replication, but eventually the immune system itself is damaged, and stops working properly. In addition, the virus can trigger infected cells to become cancerous, causing leukaemia, lymphoma and (occasionally) sarcomas.

What cats are at risk?

Unvaccinated cats who come into even casual contact with infected carriers. Indoor cats are relatively safe, unless infected animals are introduced (or come in of their own accord).

What are the symptoms?

In the early stages of the disease, there are usually no symptoms - only when the immune system has been severely damaged, months or years after infection, do symptoms become visible. Immunosuppressive disease (i.e. disease caused by collapse of the immune system) may present in a range of different forms, but often include runny noses, sore eyes, persistent diarrhoea, sores in the mouth or gums, chronic skin or ear infections, or an unexplained fever or weight loss. In all cases, minor low-grade infections develop rapidly and may even become life-threatening. Neoplastic Disease (due to the development of virus-induced cancers) typically cause weight loss, obvious masses (e.g. swollen glands), diarrhoea, or anaemia. Sometimes, there may also be neurological signs (wobbliness or even seizures) if a tumour forms in the nervous system.

How is it diagnosed?

There is a simple blood test we can carry out at the practice to confirm whether a cat is carrying FeLV (we would usually test for FIV at the same time).

How can it be treated or managed?

There is no cure for the disease. In the case of a cat who is incubating the disease but has not yet developed symptoms, it is really important to isolate them from at-risk cats - ideally by keeping them alone as indoor cats. This will also reduce their exposure to other diseases that may take advantage of their weakened immune system. The use of human anti-AIDS drugs may slow down the development of disease, but these drugs are difficult to dose safely in cats, and will not clear the virus completely.

Can it be prevented?

Yes, there is a highly effective vaccine available as an optional part of your cat's routine boosters.

FLUTD

What is it?

FLUTD, or Feline Lower Urinary Tract Disorder, is the commonest cause of "cystitis" in cats. However, it is not in most cases associated with infection, and may be best described as a response of the cat to external stimuli.

What causes it?

The main cause of FLUTD is stress. Cats do not cope with stressful situations well, and one way they respond is by developing symptoms of cystitis. Stressful events for a cat may be obvious, such as rehoming, moving to a new house, new people visiting the house, or fighting with other cats. However, in many cases, the stressor is much more subtle - seeing a strange cat through the window, a change in household routine, or even moving the furniture. Additional risk factors include insufficient water intake, the formation of crystals in the urine (typically due to diet), or unwillingness to use the litter tray (for example, because it is dirty or there aren't enough for the number of cats).

What cats are at risk?

All cats are potentially at risk of FLUTD, but some seem to cope better with stress than others. In general, the condition is most common in young and middle-aged adults (in cats over 8 years of age, by comparison, bacterial infections become increasingly common causes of cystitis symptoms). Obesity is also an important risk factor; and neutered tomcats are at the highest risk of developing an obstruction ("blocked bladder").

What are the symptoms?

Straining to pass urine, pain or discomfort when urinating, and the passage of frequent, very small amounts. Often, urine when passed is bloodstained. Sometimes, the urethra (the tube carrying urine from the bladder to the outside world) becomes obstructed with debris or microcrystals. These cats (usually tomcats, most often neutered) are unable to urinate at all and will be in severe distress - this is an EMERGENCY that needs immediate veterinary attention.

How is it diagnosed?

It is the most common cause of cystitis, and in a young cat presenting with these symptoms, the most likely diagnosis. Other conditions (such as bacterial infections or bladder stones) can usually be ruled out with a urine test.

How can it be treated or managed?

The best way of managing FLUTD is to resolve, or manage, the underlying stress. If it isn't something that can be reversed, the use of Feliway pheromone products is invaluable, and sometimes prescription medications to reduce anxiety. Meanwhile, the condition itself can usually be managed with pain relief, increased water intake (for example, feeding a wet diet), and sometimes glycosaminoglycan supplements. In the case of a cat with a blocked bladder, hospitalisation is urgently required; the vets will pass a urinary catheter to gently flush away the obstruction and to ensure the cat can urinate properly before going home.

Can it be prevented?

The best way to prevent FLUTD is to address the risk factors (keep your cat at a healthy weight, feed wet food, in high-risk cats consider a urinary diet) and be alert for possible causes of stress - acting to relieve them as early as possible.

HCM

What is it?

HCM, or Hypertrophic Cardiomyopathy, is the commonest heart disease in cats.

What causes it?

HCM occurs when the muscle in the cat's heart becomes excessively thickened. This might sound a good thing - a thick strong heart should mean a more efficient heart - but in HCM this process proceeds so far that the heart, although very powerful, is unable to fill with blood properly, resulting in abnormal blood flow, blood clot formation, and ultimately heart failure. There are two well recognised underlying causes of HCM - a genetic mutation and hyperthyroidism.

What cats are at risk?

Hyperthyroidism may occur in any older cat, and often results in HCM. The genetic disease is most common in Maine Coon cats, although it has also been recognised in some Shorthaired breeds and Persians, among others. The genetic condition usually presents in young to middle-aged adult cats, and toms are thought to be at an increased risk.

What are the symptoms?

In most cases, the initial symptom will sudden-onset heart failure or thromboembolic (blood clot) disease. Symptoms of heart failure in cats include exercise intolerance, difficulty breathing, collapse, pale gums, weak pulses, and even sudden death. Blood clots are more common, and may lead to sudden onset acutely painful paralysis (usually of the hindlimbs), a stroke (causing abnormal behaviour, blindness or paralysis), or a pulmonary embolism (rare, usually causing severe distress, difficulty in breathing and sudden death).

How is it diagnosed?

There is a blood test that is a useful screening test for heart disease in cats, but the only way to diagnose HCM is with an ultrasound scan of the heart (echocardiography). A heart scan like this can also assess how likely blood clots are in the near future, as micro-clots are visible as "smoke" in the left atrium of the heart.

How can it be treated or managed?

There is a licensed medication (diltiazem) for HCM, which is designed to allow the heart muscle to relax, so the chambers can fill more effectively with blood. In addition, it is increasingly seen as good practice to prescribe certain blood-thinners to cats with HCM, to reduce the risk of blood clots forming,

Can it be prevented?

Unfortunately, there is no way to prevent the genetic disease except by not breeding from known carriers. Good control of thyroxine levels in cats with hyperthyroidism will, however, usually prevent them from going on to develop HCM.

Hyperthyroidism

What causes it?

In most cases, it is due to a (benign) tumour in the thyroid gland. This tumour makes thyroxine, but does not respond to the signals from the brain telling it to stop when it has made enough, so thyroxine levels continually rise. Thyroxine controls the cat's metabolic rate, so an excess of thyroxine increases their basal metabolic rate, causing psychological and physiological hyperactivity.

What cats are at risk?

Hyperthyroidism is primarily a disease of older cats and is most common over the age of 12 years. It is very rare under 6 years of age.

How is it diagnosed?

A simple blood test will diagnose abnormally high levels of thyroxine in most cats. Occasionally, the levels appear falsely normal because of another illness (sick euthyroid syndrome), and the hyperthyroidism cannot be diagnosed until the other disease (e.g. kidney failure) has been treated.

How can it be treated or managed?

There are 4 treatment options. The simplest is with diet - a special low iodine diet is given. The thyroid needs iodine to make thyroxine, so by limiting iodine, you limit production. This only works if the cat eats only the special food, without any treats, snacks or live prey. More commonly, we would use certain medications (carbimazole or its derivatives) - daily or twice daily tablets are very effective at controlling the condition in most cats. The condition can be managed medically, but for a "cure", the cat will need to undergo surgery - once the cat has been stabilised with diet or medication, we would remove the overactive thyroid gland. If this isn't an option, there is also a more modern approach, using Radioactive Iodine Treatment - the cat goes to a veterinary referral hospital where they can be given nuclear medicine treatment to destroy the hyperactive thyroid gland.

Can it be prevented?

Sadly, there is no way to prevent feline hyperthyroidism.

Chronic Kidney Disease

What is it?

CKD, also known as Chronic Renal Failure or Kidney failure, is a progressive loss of kidney function - sadly, it is very common in cats. A cat's kidneys play a vital role in filtering waste products and toxins out of their blood; they also control the production of red blood cells (to carry oxygen) and help to regulate blood pressure.

What causes it?

The kidneys have a reserve capacity (the "functional reserve") of about 60%. Throughout life, some of the nephrons (the actual filtering tubes) will be damaged or lost, due to disease, injury or (most commonly) old age and overwork. Eventually, so many have been damaged that the kidney's function is impaired - we call this Chronic Kidney Disease, to distinguish it from Acute disease where an injury, shock or poisoning has destroyed or damaged large amounts of the kidney tissue in a single event.

What cats are at risk?

All cats - in fact, most cats over the age of 12 probably have some degree of kidney disease.

What are the symptoms?

Typically, symptoms of CKD develop gradually and insidiously. The usual signs are weight loss, increased thirst and increased urination. As waste products and toxins build up in the bloodstream, a strong metallic smell and ulceration of the mouth may develop, followed by dehydration, seizures, collapse and then death. Other possible effects of kidney failure include anaemia (pale gums and difficulty catching their breath) and high blood pressure, which can cause blindness or strokes. Many affected cats also have unusually low blood potassium levels, causing muscle weakness - typically, a drooping head carriage.

How is it diagnosed?

The most common way to diagnose kidney failure is with a blood test - increased amounts of wastes such as urea and creatinine can easily be detected, as can low red blood cell counts in anaemia. Urine tests are also useful, as the cat's diseased kidneys cannot concentrate their urine as much as in a healthy cat, plus they also tend to leak protein. Tests of blood pressure are also very important to determine whether eye and brain damage are likely.

How can it be treated or managed?

There is no cure for CKD in cats (kidney transplants are technically possible, but are banned in the UK). However, the disease can usually be managed with appropriate diet, free access to water and medication. A cat with kidney failure requires a diet with the minimum QUANTITY of high QUALITY protein, low phosphate levels and high potassium levels. This is usually best provided with a specific renal diet, but if a cat will not eat it, a phosphate binding agent and supplementary potassium can be added to their normal diet. Free access to water will help to combat dehydration, and medications such as ACE inhibitors will reduce protein loss through the kidneys and help to stabilise blood pressure. If the cat's blood pressure is dangerously high, other drugs such as amlodipine may be needed to reduce it to a safe range.

Can it be prevented?

No, there is no way to prevent CKD. A good quality diet, and avoidance of toxins such as antifreeze may delay the onset, but it is probably inevitable if the cat lives long enough.

Pancreatitis

What is it?

Inflammation of the pancreas in the cat's abdomen is a remarkably common condition, and if mild may not result in any apparent symptoms. However, severe cases are serious and even potentially life-threatening.

What causes it?

The pancreas has two functions - producing pancreatic juice to help digest food, and producing hormones (such as insulin) to manage blood sugar levels. In pancreatitis, the pancreas becomes inflamed - either because of injury, a tumour, infection or an inflammatory disease. Cats are most prone to Chronic Pancreatitis; this occurs when there is a relatively mild original injury (in fact, we don't usually ever find out what it was), that causes the gland to leak pancreatic juice. This starts to digest the inside of the gland, causing a little more injury, causing more leakage, and so on. This often grumbles on for weeks or months, with no obvious symptoms, but may eventually become severe enough to be apparent.

What cats are at risk?

All cats - in fact, studies suggest that as many as 45% of apparently normal cats actually have mild chronic pancreatitis!

What are the symptoms?

They tend to be very vague and intermittent, making chronic pancreatitis hard to diagnose. Most commonly, weight loss, depression, lethargy, and reduced appetite, occasionally causing intermittent vomiting. Sometimes, the damage will become so severe that Acute Pancreatitis develops, with profuse vomiting, complete anorexia, jaundice, severe abdominal pain, dehydration and collapse.

How is it diagnosed?

There is a blood test (Feline Pancreas-Specific Lipase) that has revolutionised our ability to diagnose the condition - it can sometimes even be carried out while you wait.

How can it be treated or managed?

In Acute Pancreatitis, hospitalisation, intravenous fluids, and assisted feeding (typically with a feeding tube) are required. Chronic Pancreatitis, however, usually has to be managed, with a highly digestible but low-fat diet, pain relief, and sometimes anti-inflammatory medication.

Can it be prevented?

No - we do not yet fully understand the underlying causes, and there is no effective preventative treatment or management known.

Toxoplasmosis

What is it?

Toxoplasma gondii is a protozoan parasite (like an amoeba) of cats. It rarely causes disease in cats, but is potentially dangerous to any other animal that comes into contact with cat faeces, including humans.

What causes it?

The parasites live in the cat and lay eggs (or oocysts) which are passed out in the faeces. These are then eaten by rodents, sheep, dogs or people who handle cat faeces without sufficient hygiene! In this intermediate host, the parasites usually form cysts in the muscles, where they lie dormant until a cat eats the host (not terribly likely in the case of a human, but the parasite doesn't know that), when that cat becomes infected.

What cats are at risk?

Any cat who ever eats live prey - about 30% of cats have been exposed at some time in their lives.

What are the symptoms?

In the cat, usually nothing more than mild, transient diarrhoea. If the cat is pregnant when she becomes infected for the first time, her kittens may be severely disabled, or aborted. In other animals, symptoms are usually mild (fever, loss of appetite, lethargy) until their immune system clears the parasites. However, if they are pregnant, there is a strong possibility they will lose their puppy, lamb, kit - or, in humans, their baby. In any animal, if their immune system is weakened by another disease, there is the possibility of more severe disease affecting any organ system, especially the brain. In addition, we now know that that parasite acts to make mice and rats less afraid of cats (to increase the chances that they will be eaten), and some researchers claim that Toxoplasma infection in humans increases the risk of depression and risk-taking behaviour.

How is it diagnosed?

Blood tests for antibodies made by the immune system to fight off the parasites - a single test isn't useful though, you need two a few weeks apart.

How can it be treated or managed?

There are a range of drugs that can kill the parasite, in all species; the most commonly used is probably clindamycin.

Can it be prevented?

Preventing cats from contracting the parasite requires preventing them from hunting, or catching fleas. To protect other animals and humans, avoiding contact with cat faeces is the best and most effective method, although there is a vaccine for use in sheep. There is no significant risk from handling cats (even if they are carrying Toxo) while pregnant, as long as good hygiene procedures are maintained (in other words, wash your hands thoroughly!).

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Runnymede Surgery

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