What’s Your Diagnosis?
This is Chang Lu, a 10-year-old Shih Tzu. Chang Lu visited Medical District Veterinary Clinic in December with a history of straining to urinate, increased frequency of urination, and bloody urine.
During her exam she was trying to urinary every few minutes and was producing small, blood-tinged urine droplets each time. Initial diagnostics included urinalysis and X-rays. Her urine revealed significant bacteria and an overabundance of white blood cells. Below are her X-rays.
What is your diagnosis?
If you diagnosed Chang Lu with urinary tract infection and urinary bladder stones (urolithiasis), then you are correct. The large egg-shaped structures should not be there. Those are large urinary calculi (stones). Below I have notated the X-ray to point out various organs.
Urolithiasis (urinary bladder stones) are common in both dogs and cats. In people, most urinary stones originate in the kidneys, but in animals, more than 90% originate in the bladder, or lower urinary tract.
Urolithiasis (Urinary Bladder Stones)
Many factors, including genetic predisposition, can lead to bladder stones. Smaller breed dogs are at higher risk of developing urinary calculi (stones). Other predisposing factor include urinary tract infections, urine pH, urine mineral composition, and urine concentration.
When we see patients exhibiting the signs Chang Lu came in with (inappropriate urination, bloody urine, straining to urinate, increased frequency of urination), the most likely cause in dogs is a urinary tract infection and in cats is idiopathic (stress-induced) cystitis. In both species, however, it is important to rule out bladder stones, especially if urinary issues have been an ongoing problem for the pet.
To diagnose urinary bladder stones, veterinarians need to look inside the abdomen using X-rays and/or ultrasound. Seeing these stones is easier on X-rays than with ultrasound, and the number of stones can be more easily counted. Unfortunately, not all stones show up on X-rays, so ultrasound is needed to diagnose the non-radiopaque stones. Luckily, those that can’t be seen on X-ray are the much less common than those that can.
Treatment for Urinary Bladder Stones
Once stones have been diagnosed, treatment usually consists of a cystotomy (surgical removal of the stones) and treating the infection, if one is present. In some cases, prescription diets can be used to try to dissolve the stones. I personally have had great success with dissolution of stones in cats but very little to no success of dissolving stones with diet in dogs.
Chang Lu underwent a cystotomy, and two large stones were removed from her urinary bladder (see photo). At the time of surgery, we took a bacterial culture of her bladder, and the results showed that she had a resistant bacterial urinary tract infection. A resistant bacterial infection means the bacteria present in her bladder was resistant to most antibiotics, including the one she was initially prescribed. She was prescribed a new antibiotic in hopes the infection would be cleared.
How to Prevent Urinary Bladder Stones
Once stones have been diagnosed, it is very important to identify the type of stone to understand steps that can be taken to help prevent re-occurrence. After any cystotomy, the stones are sent to the University of Minnesota Urolith Laboratory, where the stones are evaluated. Knowing the mineral composition of the stone helps veterinarians determine the best way to prevent stones in the future. In many cases, pets are started on a long-term prescription diet to help alter their urine pH, encourage urine dilution, and limit the mineral components of the diet that lead to stone formation.
Chang Lu’s stones were determined to be 100% struvite stones, most likely secondary to her resistant bacterial infection. After she finished the course of new antibiotics, her urine was re-cultured, and the infection was completely cleared. Moving forward we will be screening her urine for infection every 3 to 6 months. She has also been switched to a prescription food designed to keep new stones from forming. Chang Lu is currently doing great and all her clinical signs have resolved.
– Dr. Drew Sullivan
With National Pet Dental Month beginning in February, the dental health of our patients is a main focus of our practice right now. While having dental procedures performed is key to help maintain dental health, home dental care is also an extremely important aspect of maintaining dental health in dogs and cats.
The goal of practicing home dental care is to prevent or control periodontal disease by reducing plaque and tartar buildup. In order to be most beneficial, this must be practiced long term. There are various home dental care options available and the combination of different methods is ideal.
The following are examples of home dental care options:
Brushing the Teeth
This is the most effective way to slow the progression of dental disease between dental cleanings. By brushing the teeth, formation of the film of bacteria on the teeth (known as plaque) is disrupted. Ideally the teeth should be brushed daily for the best results. Introducing your pet to brushing when they are younger is easiest for both you and your pet. Your pet will likely resist having the teeth brushed at first. Please remain patient and persistent, as it will take some time for them to get used to it.
Be sure to use a pet-safe toothpaste and avoid using human products. Toothpastes come in a variety of flavors, so hopefully you can find one that your pet will enjoy. You can also try a variety of pet toothbrushes styles until you find one that works best for your pet.
As with brushing, it may take time for your pet to adjust to the taste and having dental rinse applied. Some rinses taste better than others. Find one your pet likes. We recommend finding a rinse that contains chlorhexidine, which is one of the most effective antiseptics and helps prevent plaque formation on the teeth.
Dental Diets and Treats
Diets and treats formulated to address pets’ dental health rely on the shape or size of the kibble and the ingredients of the food to effective. The diets can be fed as the main diet and also as treats. Examples of prescription diets include Hill’s Prescription Dental t/d Dental Care, Royal Canin Dental Care, and Purina Pro Plan Veterinary Diets DH Dental Health. There are also over-the-counter diets and treats available without a prescription.
The Veterinary Oral Health Council’s (VOHC) Seal of Acceptance is awarded to home oral hygiene products that meet or exceed the VOHC standard for slowing down the accumulation of dental plaque and tartar. Check out these links to learn which products have the VOHC Seal of Acceptance:
Dogs – http://www.vohc.org/VOHCAcceptedProductsTable_Dogs.pdf
Cats – http://www.vohc.org/VOHCAcceptedProductsTable_Cats.pdf
Taking an active role in your pet’s dental care will help reduce dental disease and potentially life-threatening heart and kidney disease, which is why it is so important! Please contact us if you have any questions regarding home dental care for your pet.
Amber Slaughter, DVM
You bring your dog to the vet every year for a physical examination and vaccinations. But do you recall why your dog is receiving her shots and how her doctor has decided which ones she needs? The following is a summary of the vaccinations we offer and the diseases they prevent.
Rabies is a virus that is contracted through the saliva (usually a bite) from an infected animal. Because rabies is always fatal and can be transmitted to humans, it is required by law that pet dogs be vaccinated. The first rabies vaccine your pet receives can be given as young as 12 weeks of age and must be re-administered one year later. Subsequent vaccines are given at either one- or three-year intervals.
DAPP, aka Distemper
This combination vaccine protects your dog from four respiratory, neurologic, and gastrointestinal viruses (distemper, adenovirus, parvovirus, and parainfluenza) that are in the environment and easy to contract through contact with an affected dog or contaminated feces. It is especially important that puppies receive this inoculation at appropriate intervals. The immune system of puppies is immature and not ready to battle these diseases. We administer this vaccine starting at 6 to 8 weeks of age, and continue every 2 to 4 weeks until your dog is at least 16 weeks of age. As your dog gets older, this vaccine will be given less frequently since his immune system is armed with antibodies to fight illness.
A bacteria found in standing water, leptospirosis is transmitted through the urine of infected rodents. A dog can contract the bacteria by drinking out of, or even walking through, a contaminated puddle. Symptoms range from mild gastrointestinal signs to liver and/or kidney failure. This potentially fatal disease is communicable to humans, so we strongly recommend all dogs receive the vaccine once a year.
There are several vaccines we give to dogs based on their lifestyles, which determines their risks.
Bordetella is the bacteria implicated in “kennel cough,” a respiratory illness that is easy to transmit through contact with an infected dog or through nasal or oral secretions. If your dog has contact with dogs you don’t know at a park or kennel, she should receive this vaccine. Puppies can get this vaccine as young as 6 weeks of age. It requires annual boosters.
The Lyme disease vaccine protects dogs against the spirochete Borrelia burgdorferi, which is transmitted by ticks. Lyme disease is characterized by arthritis, lameness, fever, and rarely, a serious kidney disease. If your dog spends any time in the woods and has exposure to ticks, this vaccine is recommended. It’s worth noting that protection against ticks is an essential part of disease prevention, since Lyme is not the only disease ticks can transmit.
Canine Influenza virus
Canine flu causes fever, cough, and fatigue and can lead to life-threatening pneumonia. It’s transmitted through oral or nasal secretions or through contact with a contaminated surface. If your dog spends time around dogs you don’t know at a park or a kennel, this vaccine is an important part of disease prevention.
Vaccinations can protect your dog from contagious diseases, some of which are fatal. As your pet’s caregiver, you should understand the preventable diseases your dog is at risk for contracting. Please call our office if you have any questions about these vaccines.
Barrie Yallof, DVM
Oh, what a typical December in a year of continual peace and normalcy.
What’s your favorite holiday memory regarding socially distanced Zoom calls with family members you haven’t seen in person for years due to splintered political realities followed by a deadly pandemic all the while keeping your 6-year-old son inside and away from his friends for 9 months and simultaneously being forced to keep an external facade of sanity and light fun in your two-holiday household while your profession, which is universally adored and undervalued at the same time, is more in demand of your time than at any other period in history?
I have so many.
So we know what usually happens here on the holiday. There is a cute blog post about keeping your dogs and cats safe, titled something like “’Tis the Wheezin’: Asthma During the Holidays.” I have written some in the past (HERE), and feel free to read. It generally can be summed up by this wise adage: “Don’t let your dog and cat eat things or get burned and remember that New Year’s Eve in Chicago generally involves people who do not have children and animals lighting off fireworks late at night to make those of us who do angry.” And don’t buy puppies, kittens, or bunnies as gifts. Instead, buy books like this inspirational tale for the animal lover in your life.
But I’m going to write about an unrelated topic: domesticated cats and the outdoors. I can imagine, even before writing this, that many people have strong feelings about this topic. My intention is not to pass judgment on anyone. I want to just give you the veterinarian perspective, and possibly give you an excuse to see photos of my fat indoor cats sitting next to holiday decorations, because that is how we indoor-cat people are generally seen and heard.
Some cats go outside. Cats go outside because some people feel that they have no choice but to let the cat out. Some people feel that it is philosophically cruel to not let the cat out, and some cats get outside by accident. All are acceptable.
I will be upfront and tell you that my two cats, Crocodile the Russian Blue mutt and Penelope the one-eyed tuxedo, do not go outside. They both try at times and have both gotten out before, but they stay inside and tolerate the complete subservience of all surrounding them.
Some of the dangers facing an outdoor cat are pretty obvious, but let’s go through them (you and I, together, like old friends who aren’t being watched):
1. Fighting with Other Cats
Cat bites and scratches are bad, cause severe infections, and can be fatal. All veterinarians have seen cats brought in with bite wounds that have become severely infected and, at worst, can puncture the abdomen, chest, eyeball, or throat and need surgical fix, hospital stays, and even euthanasia. We clean it up and give antibiotics, but it’s always concerning. This also can lead to:
2. Spread of Infectious Disease
Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are spread through the exchange of bodily fluids (blood, saliva, etc.). Let’s just assume that the cats outside getting into fights are mostly ones that are homeless, and that homeless cats comprise the largest population of cats carrying these viral diseases. Well, the logic chain/train follows, and you see the danger. We can vaccinate for FeLV, so if your cat does go outside, you can get this done. There is no vaccine for FIV. And no treatment for either disease.
3. Other Infectious Disease
Rabies is a classic viral hit and can be spread through other cats or wild animals (bats, skunks, foxes). Make sure your outside cat is vaccinated for rabies, not only because it is the law but also because, even though it is rare, your sweet rabid cat can kill you and your family. (Still waiting for the Hallmark Channel’s Very Special Rabies Christmas.)
Just for fun let’s add endless respiratory infections (that can pass on to the other cats in your house), feline distemper (get your cat vaccinated for that, too), and parasitic diseases such as fleas (get monthly flea protection), ticks (get monthly tick protection), ear mites, intestinal worms (have monthly dewormers given), and ringworm.
All but one of these diseases can be passed on to you, your children, your grandparents, their friends, their friends’ neighbor, your friends’ neighbors’ son’s cat, etc. You see how this works. If you have an outdoor cat, and you’re afraid to tell your veterinarian (which you shouldn’t be), you can still take all the precautions: vaccines, preventatives, etc.
4. And Even More Infectious Disease
For the lucky, cats bring home presents, such as mice, birds, rats, etc. The rodents bring diseases and other rodents. It’s endless.
5. Cats Get Hit by Cars…
… get hit by bikers, get stuck in garages, get hurt by bad people, get snagged on fences, freeze to death, etc. [Cut to unwatchable montage of more horrible things.] It happens.
My previous cat got stuck in someone’s garage. I could not find her and searched for hours around the neighborhood. I eventually heard a cat crying in a garage and called the police who, hours later, located the owner who wasn’t on premise, to open the door. That could have easily gone another way, and I will write that fan fiction novel later.
“Lost cat” signs litter my current neighborhood, and you know they aren’t lost with a hobo bag on a train. They are all either dead, or (at best) living their lives with someone else. Also please have your outdoor cats microchipped. It’s not painful and may save your cats’ lives. You can also buy GPS trackers for their collars. I am not promoting a specific brand, but they are available anywhere.
Cats are really good at making babies, causing the population of stray cats in the city to blow up. These cats either end up being helped by people/shelters that can barely deal with the cats they have or they are left to fend for themselves on the streets to die, starve, or spread more disease.
So first, get your outdoor cat spayed or neutered. It is absolutely the best thing for them, for their health, and to keep down the population of wild cats in need. I also do not need to explain to you how a wild tom cat will treat a sweet young lady cat taking a stroll down the promenade with her uterus and ovaries. If you want to reduce the chances that your boy cat doesn’t get into a fight, well, then neuter. There are conflicting statistics, but most sources suggest that one female cat and her mate and all the subsequent offspring amounts to 11 million cats in nine years.
Lastly, I fear that some of you feel like the most natural thing for the world is to let your cats outside and let them live the full entirety of their existence. I get this, I really do, but also understand how much destruction to the natural environment cats do. They destroy natural foliage and other wildlife despite their good intentions. There is some very good evidence that the best thing for “nature” is to keep your cats inside, and you can find many other resources on this topic.
There are cats that do better when they go outside. I’ve had clients keep their cats inside and later see them become anxious, yowl, not eat, urinate all over the house, etc. I don’t want your cats to suffer, but if you want to make that transition, there are things we can do. It may not be the case that your cat is anxious because it can’t go outside. In fact, it may be that it has always been anxious, but you never noticed until you kept it inside. Always have us examine your cat before making any judgments. Maybe your formerly outdoor cat is suffering from something else (UTI, pain, etc.).
As always, feel free to discuss with us at any time. This wasn’t meant to be a philosophical treatise on domesticated animals’ rights, though that is generally how I fantasize spending a great deal of my off time.
Try to relax during these times and make sure you don’t feed your dogs chocolate-covered antifreeze-infused garlic balls for the holidays, or give your cats kerosene holiday lamps for Hanukkah.
I will continue to lord over Secret Santas everywhere while I fulfill my long-standing December tradition of making holiday cookies I can’t eat in a house I don’t own.
Be safe, don’t travel, wear masks, and shop locally on-line. And Black Panther is a holiday movie.
— Brett Grossman, DVM
If you’re like my dad, you’ll spend an extra five minutes circling or waiting for that closer parking spot outside of a store. During those five minutes, someone else has parked in a spot that is farther away and is already in the store.
Buying heartworm, flea, and tick preventives online can be just that like. Sometimes going that extra mile to get what may be just a bit of a savings ends up setting you back more than you know.
Online Is Often Not Cheaper
When you look at the prices of a single dose of most preventives, online pharmacies like Chewy.com and 1800petmeds.com are less expensive. But when purchasing product to cover 6 or 12 months, we are actually less expensive.
Right now, for Nexgard, when you buy 6 doses from us, you get an additional 2 free. This is about a $50 savings. And you get 3 free doses—a $75 value—when you buy 9. For Sentinel, when you apply the rebates offered here, we are less expensive when you buy 6 or 12 doses. (These are according to prices as of November 2020.)
Sentinel Spectrum Comparison Shopping
|Weight class||6 doses||12 doses||6 doses||12 doses|
Nexgard Comparison Shopping
|Our prices||Our prices||Chewy.com||Chewy.com|
|Weight class||6+2 doses||9+3 doses||6 doses||12 doses|
Most preventatives have guarantees on their products. For example, if your dog is on Nexgard consistently and does end up getting fleas or Lyme, Merial will cover testing and treatment, including a home inspection of your home in case of fleas, and up to $5000 in diagnostics and treatment for Lyme disease. But this guarantee is often only honored if the products are purchased from a veterinarian. Purchasing from an online source can void the guarantee.
A Final Word
This post is not meant to discourage anyone from keeping their pets protected. We recommend year-round preventives for heartworms, fleas, and ticks for dogs. Cats that go outdoors or live with a dog in the house should also be protected.
So, if you prefer to find these products online, then we will happily approve any online request for all of your up-to-date pets. But remember: if the pricing looks too good to be true online, it often is.
Alyssa Kritzman, DVM
Life with an elderly pet brings a lot of uncertainty and anxiety. We all wish for our pets to be comfortable and happy and live as long as possible, but interpreting subtle signs shown by aging pets can be challenging.
I can relate on a personal level. Our 14-year-old mixed breed dog named Oskee was diagnosed with thyroid cancer a few years ago. My wife and I did not think he would still be with us today. He has done better than expected for a dog with this diagnosis.
We feel very fortunate that he is doing relatively well. Recently, however, we have been noticing changes that make us wonder if this is the beginning of the end.
Facing the Inevitable
How do you know if he is uncomfortable? Is he suffering? When the time comes, how will our children react? Will we know when it is time?
These are all questions that many clients are faced with, and now my wife and I are the ones contemplating them.
When you are faced with these or similar thoughts and questions, I recommend making a list of things your pet really enjoys. For example, Oskee enjoys going for walks, chewing bones, begging/taking food from our kids. As he has aged and his condition has declined, we have seen his enjoyment in these activities decrease.
Some days he does not seem to have the energy or strength to go on much of a walk. Occasionally his legs slip out from under him. He also spends much more time sleeping and is not waiting by the dinner table like he used to. Noticing these changes helps us determine a “good” day from a “bad” day.
Focus on Quality of Life
Fortunately, his good days still outnumber the bad. An anti-inflammatory pain medication seems to make him more comfortable, and he does pretty well. I recommend clients keep a journal of good and bad days. When the bad days start outnumbering the good days, the pet’s overall quality of life needs to be considered.
For those of you with aging pets or terminally ill pets, I recommend discussing with your veterinarian what medications or therapies may help improve your pet’s overall quality of life. Unfortunately, though, most of us will be faced with a very difficult decision: when is it time to say goodbye?
It is never an easy decision. No matter how sick or old your pet is, the decision is going to be gut-wrenching and difficult. My wife and I are not looking forward to making this decision, but I owe this to Oskee when the time comes. Oskee has been the best dog for the past 14 years, and I would never want to see him have anything but a good quality of life.
Dr. Drew Sullivan
Cats make great pets for city dwellers; most indoor cats are content to live in small spaces, passing the day asleep on a bed or couch, waking for meals and litter box use. They don’t need to be walked outside and they are a great source of love and companionship. Chicago offers many rescue groups and shelters that can help you select and adopt a life-long friend. PAWS and the Anti-Cruelty Society are two such organizations.
Many indoor cats, however, find confined living stressful and act out in ways that are undesirable to their owners. Two of the most common unwelcome behaviors are eliminating out of the litter box and scratching furniture and rugs.
This article outlines some of the ways to make your indoor cat’s existence happy. Because behavior problems can be rooted in medical causes, be sure to contact your veterinarian if you are concerned about your cat.
Think Inside the Box
Excellent litter box hygiene is essential for curtailing inappropriate urination and defecation. Cats are fastidious, so may choose to avoid using an unkempt box. Eliminating out of the box is not a spiteful behavior; it may be, in the cat’s mind, the best alternative. Removing waste daily is recommended.
Make sure you have enough litter boxes for the number of cats in your home. Veterinarians recommend the number of litter boxes equals the number of cats plus one (e.g., two cats demand three boxes).
Lastly, choosing a litter that is acceptable to your pet can be achieved by trial and error. Most cats prefer a low dust, unscented clumping litter.
Cats are natural scratchers; scent-marking glands in their paws announce to the world that a particularly well-upholstered couch or loveseat belongs to them. Their owners, however, may take exception.
There are some interventions that may be helpful to curb this habit. A scratching post, which can be placed either near or distant from a couch, may be an effective alternative. Strategically deposited catnip may lure your cat toward the desired spot. Regular clipping of your cat’s claws may also deter scratching. Additionally, clear tape applied at the arms of a couch is offensive to cats and can turn them off from scratching your furniture.
Outdoor cats climb trees to get away from predators, chase birds and other small prey, and get some alone time. Indoor cats need a similar escape. A homemade or purchased cat tree is a great way to offer your indoor cat the vertical escape she needs. This multi-level structure with comfortable places to sleep and play is one of the remedies for reducing stress and undesirable behavior in a small city dwelling.
Food, shelter, litter boxes, and love can change the life of an unwanted animal. Consider adding a cat to your home. You may be rewarded with unconditional friendship and love.
Dr. Barrie Yallof
I recently came across the most amazing carrier for producing a calm cat. It’s called the Van Ness Calm Carrier. It has a sliding drawer design that allows cats in the carrier to be very easily taken out, avoids the more forceful removal from the carrier, and allows for quicker and safer unloading. I was amazed by this simple and genius idea and surprised that this carrier wasn’t more widely used.
For many cats, the only time they leave their homes and see the carrier is when they are going to the vet. They associate the carrier and the departure with being at the vet, and they begin to feel heightened stress and anxiety even before they arrive. Once we see many of these cats, it can be very difficult to handle them, and just getting them out of the carrier can be a challenge.
As a hospital that utilizes Fear Free® practices on a daily basis, we at Medical District Veterinary Clinic do our best to lessen anxiety and stress for our patients before, during, and after their visits to the vet. While the carrier choice seems simple, this important step can make a huge difference in creating a calm cat.
Below are tips to help lessen anxiety and stress for your cats when they visit with us:
- The best carriers are hard sided carriers that can be easily taken apart. In a carrier in which the top can be easily removed, more stressful and fearful cats can even be examined while they remain in the bottom half of the carrier where they are more comfortable.
- Make the carrier comfortable and enjoyable for your cat. Ideally your cat will enter the carrier on their own, and even spend time there to rest and play. To help your cat see the carrier as a happy and positive place, fill it with treats, toys, and familiar bedding that they enjoy.
- A product called Feliway® emits a synthetic feline pheromone that helps create a calming environment and reduces stress. It comes as a plug-in diffuser, spray, and wipe. Use of these products in the carrier prior to transport can be very beneficial to limit the anticipated stress and anxiety of going to the vet. We use these products all the time and see positive changes in our patients.
- Consider asking your veterinarian for a prescription medication you could administer before your cat’s visit to the clinic to serve as a mild sedative and help reduce stress and anxiety. Common medications used include gabapentin and trazodone.
By following these guidelines, you can make the experience of going to the vet much more enjoyable for feline patients—and for owners and veterinary staff as well.
—Amber Slaughter, DVM
It’s the fifth month of a global pandemic, and you have finally decided to bring your super not-sick cat into the clinic for what will only be a regular annual exam, because nothing will ever happen to her and she is perfect and actually named after a minor character in a science fiction mini-series from the ’70s whose reference you will always be surprised is picked up by your vet who tends to type and talk in run-on sentences.
So all is going well.
You are sure of it.
You are waiting a tiny bit too long and you start to remember how your last sick cat once came to the vet and you had to wait 15 minutes extra and then got bad news. But then I come to your car and say that everything looks good [exhale], the annual blood work is normal on Meow Lamba [exhale], but …
BUT BUT BUT!!!!!! [heart sinks because this is not how the day was supposed to go and–what will it be?]
… but your sweet little cat has a very mild but notable heart murmur. You then hear nothing but a funeral march played on Moog synthesizers because Meow Lamba would want it that way.
As I say “heart murmur,” I see everyone’s face do one of two things: Eyes dilate and widen, mouth slowly goes agape and you are about to fall apart, or the muscles form the physical equivalent of “OK, Doc, be straight with me: how many months do I have left with her?”
I have to intervene immediately and dilute the words a bit, allowing you to fall back to earth and be able to talk out the rest.
And so: heart murmurs. Why do we often say not to worry, and then sometimes tell you to worry? Why do we send you to the cardiologist immediately sometimes, and more often tell you to monitor? Why did your last vet say you can never do a dental on her, and now I am telling you we can?
Let me help you. As with everything, each doctor has her own protocol, but I will give you some basics to consider. Each individual case may be different.
What is a murmur?
Lub Dub-Lub Dub-Lub Dub is the sound of the valves of the heart taking turns to close and effectively push blood through the heart. It’s not the only thing doing so, but gets most of the credit. Occasionally there will be some form of pathology to the valves causing them not to shut properly. Like a rattling screen door that doesn’t fit in the frame after years of humid summers and dry winters, the valves sometimes become misshapen or inflamed, causing the beautiful tell-tale lub-dub of the heart to sound more like lub-a-swish-dub-lub-a-swish-dub.
I liken it to someone turning up the reverb on a snare drum, but this analogy nails it for about none of my patients. So don’t worry when that means nothing to you.
To avoid making this into a veterinary textbook, I am not going to go into the pathophysiology of every reason a cat could get a heart murmur, but there are many: from congenital disorders (cats are born that way), to innocent ones caused by nothing at all, to underlying diseases (hyperthyroidism, etc.), to metabolic status (anemia, dehydration, high pressures, etc.).
The important thing to remember is that a heart murmur can be the result of something very serious, but in itself is not an emergency or an actual indication that a cat’s heart is progressing toward failure. I say this to a lot of clients, but my last cat (who was not named after a minor science fiction character) lived to be about a billion years old and had a Grade 3 heart murmur for all of those years with no clinical signs or progression.
This is not the same for every cat, though.
And then here is my first question: Is this a new murmur, or this is an old murmur that was either very hard to hear or the circumstance today (like being sick) is making the murmur sound more noticeable? Being dehydrated, sometimes being sedated or under anesthesia, being calmer or more excited can make a hard-to-hear murmur easier to hear.
If this is genuinely a new murmur, my next question is to understand if there are clinical signs of heart disease going on at home. These include coughing, wheezing, congestion, fluid from the nose, exercise intolerance, lethargy, or any type of respiratory noise. Now generally what happens is that when you hear about the murmur, you start to remember every single sneeze, wheeze, and cough that the cat (which was previously doing fine, with no issues) has had over the past year. It’s not that I discount the amended history, but heart disease is not the primary rule-out for any of the above clinical signs, so I take reports of these issues in context.
And if these things are not going on and the cat is still doing fine, then comes the choice of what to do. The most aggressive thing is to take x-rays to look at the size of the heart, to assess if the murmur is associated with other issues. Then sometimes, regardless, we discuss going to see a cardiologist where an ultrasound of the heart can evaluate those valves very specifically and make sure there is nothing going on.
Certain breeds of cats are more prone to issues, including the tragic and lovable Maine coons, Ragdolls, British shorthairs, Sphynxes, Norwegian forest cats, and Siamese. With these breeds, I generally err on the side of caution, but generally a happy healthy domestic short-haired cat that has a mild murmur and nothing else I will monitor and watch. I think it’s good to come back in a few months to recheck the murmur to make sure it is not progressing.
We do dentals and other anesthetic procedures all the time on cats with murmurs. It’s not that we don’t have to worry about it; it’s that we do. We take many precautions and monitor closely for any issues that are occurring during anesthesia. I think that sometimes cats with mild heart murmurs suffer much more from things like severe dental disease that goes unchecked because of the fear of putting them under anesthesia.
To be clear, you want to avoid anesthesia if possible, but it is not something that has to be avoided at all costs. Sometimes, again, going to a cardiologist before is recommended (and the safest things you can do).
I should say that despite my assurance that a heart murmur doesn’t always mean the worst, it can be. I don’t want anyone who is still reading this to think that I think that heart murmurs are a scam. There are animals that acquire heart murmurs and it is an early indication of heart disease that is serious. What you need to remember, though, is that there is a subtlety to it that is not so simple. Part of why annual exams on your cats are so important is so we can catch things like first-time heart murmurs and make sure that we are preventing any possible disease before it gets bad.
Shop local, love your cats, watch ’70s Canadian sci-fi,
Brett Grossman, DVM
Medical District Veterinary Clinic
We have now been living with COVID-19, the disease caused by the novel SARS-CoV-2 virus, for four months (officially) here in Illinois. Chicago and much of Illinois have moved into Phase 4 of the Restore Illinois response plan, and summer is in full swing.
It has been a strange and distressing time for us and for our pets.
My dog Emmie fits in perfectly with social distancing, due to her long-standing leash aggression and dislike of other dogs! (We’ve been working on those issues for a long time, but maybe not as seriously as we should have.) On the downside, the pandemic also means that we probably won’t be taking Emmie to any of her favorite spots, like the dog beach, for a while.
Current COVID Recommendations
Here are some current facts and recommendations from the American Veterinary Medical Association (AVMA) about COVID in cats and dogs. Remember, though, that there is still a lot we don’t know.
- Routine testing of animals is not recommended by most regulating and professional groups, including the AVMA, the Centers for Disease Control and Prevention, and the USDA.
- Testing can be done when an animal appears to be showing clinical signs and has had prolonged close contact with a person that is COVID positive or in a facility that is high-risk (nursing home, etc.).
- There is no evidence that animals play a significant role in spreading COVID to people. This disease is overwhelmingly transmitted person-to-person, but it is always recommended to wash your hands after interacting with animals.
- In rare instances, there is evidence that people can transmit COVD to animals, and in those cases, fever, lethargy, and respiratory signs have been noted. Most animals responded well to supportive care.
- If you are positive for COVID, you should minimize contact with your pets as much as possible.
Consider Your Pet’s Stressors
While disease prevention and management for us and our pets is important, it’s also important to think about how the many changes in routine are affecting the lives of our pets. You might think having their owners working at home would be the best thing that ever happened to our pets, but that’s not necessarily the case. Here are some points to consider:
- Even though most animals may be glad you’re home more, it’s still a major change in their routines, which can be very stressful. Try creating a new routine that gives your pet some time away from you. For example, take a walk or drive on your own or participate in a safe social distancing visit outside so your pets are still used to you being away at times.
- Be sure that your pets have a space, even if small, that is their own. No one should be allowed to bother them when they are in that crate, on that certain dog bed, or in “their” room.
- Try not to reinforce attention-seeking behaviors. Even negative attention is attention. Instead try to redirect and focus your pet on another activity if you need them out of your space while you’re working or if they are doing something, you’d rather they not do.
Play It Safe
Finally, how to we manage socialization with other dogs? The city of Chicago has not yet reopened their dog parks. Even after the parks reopen, we recommend minimizing their use as much as possible.
Lots of dogs present means more people around, which can make it harder to social distance. Although there is no evidence that COVID can be transmitted dog-to-dog or dog-to-person, the less contact with other family units the better.
Just a few weeks ago, I witnessed a dog fight in a local park where dogs were off leash playing. Luckily, no animal or person was significantly injured, but the owners had to physically separate the dogs, which meant close contact—and they were not all wearing masks when this happened, because it happened so suddenly.
I get it, though. Some dogs need the socialization, and at some point, our pets and our own mental health are important to consider. Some dogs would go bonkers without a good play session.
If possible, try to find a small group of dogs and people that you know and stick to a private area, like a friend’s backyard. But if you must go to a public area, try to go at non-peak hours, wear a mask that covers your mouth and nose, social distance, carry hand sanitizer with you, and be sure to wash your hands after interacting with your pets.
Stay safe everyone!
–-Dr. Alyssa Kritzman