Sunday, May 7, 2017

Ask the Vet With Dr. Kris: Dr. Kris Answers April’s Questions


In February, we launched our new “Ask the Vet With Dr. Kris” segment. Once a month, we’ll post a reminder for you to post your questions for Dr. Kris. He’ll answer as many of them as he can each month, and I’ll publish his answers in a subsequent post.

Dr. Kristopher Chandroo is a veterinarian, scientist, photographer, animal welfare advocate, and creator of Stress to Success (STS): The Essential Guide to Medicating Your Feisty, Grumpy or Reluctant Cat.  Dr. Kris wants  your cats to be twenty years old. And counting! And he wants to provide medication and therapy to them in a way that respects the bond between cat and human.

Here are Dr. Kris’ answers to some of your questions asked in March. If your question didn’t get answered here, Dr. Kris will answer them on his own website, in the future. Subscribe to his updates so you’ll be notified when the answers are published.

Was cat overdosed on thyroid medication?

Why do vets insist on overdosing cats with the hyperthyroid medicine methimazole? It’s been proven it’s better to start at a low dose and increase gradually until an ideal T4 is met, rather than risk the complications of an overdose and compromise the kidneys. I’ve had two cats with this terrible disease and both were initially overdosed, with one recently dying from the effects of too strong of a dose. I’m heartbroken and angry at the same time that vets still continue to overdose cats on this powerful medicine. (Janet)

Dr. Kris:

I don’t know.

I don’t know what’s happening in your world, and what happened to your cats during their treatment.

But I’m sorry to hear that you lost your cat.

I do know that you are heartbroken and angry. You didn’t have to say that for me to have known that. Who wouldn’t be? When you tried to make something right, made a choice, and things ended up wrong.

We can be consumed by guilt when that happens. Some of us get angry. We find places to put the blame. I’m going to answer the technical part of your question. I’m going to share my experiences, and if it helps you, then I’ve done what I’ve set out to do. It may not change how you feel though.

The starting dose for methimazole comes from a big book that gets updated every few years, which in turn comes from published studies that evaluate for effectiveness and safety. To that, you add your experience and discretion, and everything else that you know about your patient, and calculate the starting dose.

Untreated, chronic hyperthryoidism can damage kidneys. But it’s twice as bad as it sounds, because as it damages the kidneys, it also hides the wreckage. When you treat a cat for hyperthryoidism, you don’t compromise the kidneys by way of methimazole. Methimazole is simply pulling back the veil. You are revealing any damage that was already done (if any). The hyperthryoidism will be fatal if left untreated. The compromised kidney can become the beacon of hope, because it can be successfully managed.

And yet none of this changes the fact that you still have lost your cat. You will still feel heartbroken. And we all blame something or someone at some time or another in our lives.

I think about loss. I think about what it’s going to be like when the ones I love are no longer here. I’ll probably feel just like you do right now.

Cat is getting sores from overgrooming her belly

I have a question about one of my cats that hopefully you can answer. She is almost 5 years old and back in the summer I noticed she is gaining a lot of weight. then I noticed her belly is bald and thought maybe it was because she gained too fast. But I have started noticing she licks and sucks her hair down there and she is starting to get little sores from it. I feel it’s a bad habit now and would love to know what to do to get her to break the habit. she doesn’t act sick or sore or anything. She acts the same as always, silly and playful and always eats and potties well. So I don’t believe it’s an illness. but I would love your opinion of it. (Janine)

Dr. Kris:

Hi Janine!

Here is the rule I live by for cats who are pulling out their fur and creating sores on their skin:

When it looks like a habit, and even feels like a habit, it ain’t a habit.

People are really good at knowing their cats. What they do and how they do it. And we describe things in terms of habits. Cause’ it’s what we humans do. Smoking. Netflix. Cheating. Gambling. People habits!

And 99% of the time, any change to the fur or skin being described as a habit is actually a system change in your cat that I’m going to find during an appointment.

That’s not to say she has something terrible or bad. Not at all.

But believe this: They can act the same, be silly, playful, eat, and use the box ok, and yet STILL you can have a cat with some sort of condition. Because that’s how cat’s roll. It’s what they do. It’s their Modus Operandi.

The little sores are likely mild dermatitis. The reasons why an otherwise happy, normal cat will develop those are numerous, and the internet will give you a million answers (from contact sensitivity all the way to anxiety).

It’s usually straight forward to find out what those reasons are at the vet.

Good luck!

5-year-old cat is limping after play

Hi Dr. Kris, Pery is my little boy, i can’t precise because he was kind of adopted, but we guess that he’s about 5. He started limping after coming from a 10m play in the garden. Has it didn’t improve I’ve taken him to the vet and then was referred to a specialist. Here’s the report: “There are signs of previous surgery and arthritis in each stifle (knee), right worse than left. Also, there are signs of cruciate ligament rupture in the right stifle. On the basis of findings I suspect current lameness is an exacerbation of a chronic problem and think it better to consider non surgical management initially before performing surgery. Given the arthritis present, surgery is likely to be of limited benefit. Exercise. Keep indoors. No climbing, jumping or rushing about for the next 6 weeks. Give me a phone if you have any queries and also a few days after you come back in about 6 weeks.The verbal advice was in fact to keep him in a crate but this would be too distressful and I just opt to keep him indoors and without toys. On the day he had some x-rays done and we found out that had surgery on both knees, because there’s pins on both and a screw on one only. He’s much better at the moment, this happened in January, but I think it’s in bit of pain. He does a few, and different noises when it’s laying down and sleeping too, that he didn’t before. Can you give me your opinion regarding the recovery time and method and also if the increasing in vocalization is related with pain? (Bruno Ferreira)

Something like that happened with the first cat I adopted, Zack. He was really really quiet in the shelter. Everyone thought he was shy, and gave him his space. Turned out he had a dislocated femur, and Jen (his first person) flipped the bill for his surgery within weeks of adopting him (she noticed he was limping and more quiet than shy would explain)!

Arthritis means inflammation. And inflammation means pain.

I would definitely treat him for pain. I would give him the benefit of any doubt there, given what he has wired up to his knees.

It can take a busted cruciate 4 to 6 weeks to heal, and then you have to “ease them back into activity”.

Yeah, I know. Easier said than done. Our cat’s have no idea why they can’t do all the things they need to do. So sometimes they also get anxious or bored.

Rest him, but see if you can keep his mind active. Like this as long as he doesn’t overdo it:

Good Luck,

Dr. Kris

How to prevent dental problems

I have two indoor cats. I’ve never brushed their teeth one of them is 3 the other is 6 and I am reading about all the dental problems cats can get as they get older. Most of my cats have lived to their late teens and I have never had dental problems. Could you give advice on how to start and what items to use for home preventative dental health for cats? (AK)

Dr. Kris:

It’s very true. Your cat’s in their teens may have no dental problems. Like Uncle Bob. You know that uncle – smokes, drinks, eats KFC religiously, and thinks that calories are the tiny creatures in your closet that sew your clothes a little bit tighter every night. And he outlives everyone!!!

But what about the rest of the cats out there. The non-Uncle Bobs? Most cats are like them.

And it’s not just older cats. I’ll see dental issues forming at 2 years of age. Sometimes younger. One of the very first things I do when I examine a cat in clinic is…look in the mouth. See what the teeth and gums are up too.

I’ll talk about what I see, almost in passing, then look up to see the response of the client. If they are totally glazed over (the “I’m just here for his vaccine and you’re 5 minutes late look”), then I move on. If they lean over, look in the mouth too, and start asking questions, I know this is a person who is going to try something to help their cat’s mouth. So I go further. Encourage more questions. Tell them what they need to know.

See, you’re one of those people. You would have leaned in, and asked a question or taken interest!

But what can they do at home they might ask? Brush their teeth.

And most people, right at that point know it’s not going to happen. You can see it on their face. They are not going to brush their cat’s teeth! They can’t clip the nails, let alone brush the teeth.

So you want to start slow. In your cat’s mind, you want to match up the sensation of eating treats with handling their mouth. This is called counter-conditioning. Give them a treat while you touch their face on Monday for a few minutes. Repeat that on Tuesday. On Wednesday, touch their gums for a few seconds with your fingers while giving them treats. Repeat that on Thursday. By Friday, rub your fingers along the teeth. Just briefly as they munch on a treat. Don’t get bit

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