An integrative approach to chronic kidney disease (CKD) in cats

By: Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MODT, MHSc (Herb Med), CVA, CVCP, CVBM

CKD is a common but manageable condition in feline patients, and responds well to integrative medicine. Herbs and acupuncture are key therapies.

Chronic kidney disease (CKD) is a common problem in cats, and one which all veterinarians encounter in practice. An integrative approach that includes herbs and acupuncture can help treat and even reverse this condition in feline patients.

CKD can be detected early through careful monitoring at annual wellness programs. IRIS (International Renal Interest Society) staging allows for the conventional staging of treatment, including any dietary changes. Key treatment strategies for feline CKD include supporting hydration, reducing phosphorus (usually through protein restriction), regulating blood pressure and controlling calcium levels. The intensity of intervention increases with disease progression.

Integrative treatment goals

Using integrative approaches to CKD, we have observed cats moving from IRIS Stages 2 and 3 to Stage 1, and remaining there for years. This reversal implies that nephrons are hypoxic and under-functioning, and that improving their functional capacity is a key goal. See below for integrative treatment goals for CKD.

Herbs can optimise kidney cell function by reducing oxidative stress, improving renal blood flow and mitigating fibrosis, thereby maintaining patients in early stages for extended periods. Acupuncture, manipulative therapies and other modalities can also be a part of the integrative approach.

With acute renal disease, the goals are modified to regulate/decongest the kidneys by reducing blood flow, and provide anti-inflammatory support to inflamed glomeruli. This may be a starting point with pyelonephritis, for example. Most cats, however, benefit from increased perfusion unless the renal disease is acute in onset (inflammatory).

Dietary considerations

Despite numerous experimental studies and clinical trials, questions about feeding protein to cats with chronic kidney disease (CKD) remain. What is the optimal amount of protein for a cat with CKD? How much restriction is necessary? Do different types of kidney disease require different dietary therapies? At what point in disease progression should protein restriction be implemented? Does the type of protein make a difference? Does every meal have to be restricted? Will a cat in IRIS Stage 3 or 4 benefit if phosphorus is restricted by other means? Might some cats with advanced disease benefit from increased protein levels?1 These concerns remain despite the common practice of prescribing therapeutic renal diets to cats in any stage of CKD.

Integrative practitioners provide, or are requested to provide, natural feeding advice to cat owners. Excellent resources include the veterinary Diplomats in Nutrition; Balance It and several software programs that can be used for formulating diets while taking feline preferences into account. See page xx for an example of a low-phosphorus diet for cats with CKD.

From an integrative perspective, real food is considered to have many benefits, including palatability for ill cats, and these benefits may outweigh those offered by processed foods. In IRIS Stage 1 and early Stage 2, the diet may not need to be modified, although serum phosphorus and the phosphorus content of the diet should be evaluated. From late Stage 2 onwards, consideration may be given to reducing protein by diluting with fat and carbohydrates.

Herbal help

Herbs can delay the onset and progression of CKD in cats by improving mitochondrial function, and providing antioxidant protection and ACE-inhibiting effects. Many herbs are anti-inflammatory, anti-fibrotic and nephroprotective, and several improve renal blood flow. A principle of herbal medicine is that formulations containing multiple plants can have greater effects than the same herbs taken separately. These synergistic effects enhance the desired action.2

Following are several herbs to be considered and included in formulas for renal treatments.

1. Rehmannia glutinosa

Rehmannia glutinosa occurs in many Chinese herbal formulas, including Rehmannia Eight Combination (Shen Qi Wan, Jin Gui Shen Qi Wan, Ba Wei Di Huang Wan), which is very useful for cats with CKD and weight loss, loss of strength, polyuria, polydipsia, and that are seeking warmth. It is also included in Zhi Bai Di Huang Wan, which is useful in cats with CKD and hyperthyroidism, particularly in those tending towards constipation, agitation and weight loss, along with polydipsia and polyuria.

Rehmannia has a long history of research and effective use in CKD. In humans, studies have found that it has a 91% efficacy in reducing renal damage from nephritis, due to the enhancement of renal blood flow and glomerular filtration.3 In a model of renal ischemia, ligated rats that received Rehmannia extract showed improved renal blood flow (to near normal levels) and reduced mortality and hypertension compared to controls, through either ACE inhibition or juxtaglomerular desensitization.4 Rehmannia reduces oxidative stress and can promote red blood cell production through bone marrow stimulation; reduce serum creatinine and urinary protein excretion and glomerulosclerosis in compromised patients; and inhibit the expression of Angiotensin II as well as Type IV collagen in the renal cortex.5, 6

Fresh Rehmannia is utilised in Ba Wei Di Huang Wan and Zhi Bai Di Huang Wan. Interestingly, a recent study supports the use of fresh over prepared Rehmannia; the former acts more powerfully on attenuating interstitial fibrosis by downregulating the expressions of transforming growth factor, a smooth muscle actin, and Type 1 collagen.7

2. Astragalus membranaceus

Astragalus membranaceus is known as a Qi tonic in Chinese medicine, and as a major immune-modulating herb in Western herbal medicine. It should also be known as a major kidney herb. Its major constituent, astragaloside, ameliorates renal interstitial fibrosis in vivo by inhibiting inflammation.8 It has major antioxidant effects.9 Astragalus has been reviewed by Cochrane and was found to offer some promising effects in reducing proteinuria and increasing haemoglobin.10 Its nephroprotective effects against oxidative stress include anti-inflammatory and anti-apoptotic mechanisms.11 In a systematic review of Astragalus on diabetic nephropathy in animal models, this herb was able to reduce blood glucose and albuminuria levels and reverse the glomerular hyperfiltration state, thus ameliorating pathologic changes.12

3. Angelica sinensis

Angelica sinensis contains polysaccharides that inhibit oxidative stress injury in mouse kidneys.13 Like Astragalus, its nephroprotective effects include anti-inflammatory and anti-apoptotic mechanisms.11 Renal microvascular lesions can contribute to the progression of glomerular sclerosis and tubulo-interstitial fibrosis in chronic kidney Both Astragalus and Angelica can improve microvascular lesions by increasing local renal blood flow to lessen hypoxic renal injury, promoting the recovery of renal blood flow and glomerular filtration rate after ischemia-reperfusion; modulating the imbalance of vaso-activators such as nitric oxide and angiotensin; increasing the expression of vascular epithelial growth factor; inhibiting the release of the intracellular calcium ion; and promoting DNA synthesis in endothelial cells to improve the function of endothelial cells. The evidence suggests that both herbs may retard the progress of renal diseases through the above-mentioned mechanisms.14

In one study involving rats with an obstructive uropathy, Astragalus and Angelica were administered with Enalapril and compared to monotherapy. Enalapril with Astragalus and Angelica decreased tubulointerstitial fibrosis to a significantly greater extent than did treatment with Enalapril alone.15

4. Cinnamon

Cinnamon is readily accepted by cats and offers a mono-herbal treatment for fussy felines. It occurs in the Wei Ling Tang formula, which is useful for overweight CKD cats with proteinuria, hematuria, urolithiasis, azotemia, glomerulonephritis and pyelonephritis. Cinnamon can inhibit advanced glycation end products (AGE) and can ameliorate AGE-mediated pathogenesis in diabetic nephropathy.16 Cinnamon is a major antioxidant and anti-inflammatory spice, and has had over 178 papers published on it from 1995 to 2015.17 Cinnamon at a dose of 50 mg/kg for two weeks was given to dogs; the systolic blood pressure and heart rate in the treated dogs was significantly lower than in the normal group.18

5. Silybum marianum

Silybum marianum is one of our preeminent nephron-protective herbs. It should be considered an adjunct to ameliorative potential effects against drug-induced kidney disease, particularly in chemotherapy.19 It is also an herb that could be considered for CKD support. It is a potent antioxidant and free radical scavenger that inhibits lipid peroxidation and stabilizes cell membranes. It also increases intracellular glutathione, which plays a crucial role in the body’s antioxidant capacity, and it has anti-inflammatory properties inhibiting T-cell proliferation and cytokine secretion.20 There is also evidence that Silybum has a regenerative effect on renal tissue after injury.21

Mushrooms — Ganoderma and Cordyceps

Mushrooms are well tolerated by cats when given in the form of powders or concentrated tinctures added to food. Ganoderma lucidum is a medicinal mushroom that has been widely used in China and Japan for hundreds of years for its immune-modulating, anti-inflammatory and anti-tumor effects. Ganoderma compounds are renoprotective.22.The active peptide in Ganoderma counteracts oxidative stress from renal ischemia, and in an animal model of diabetic nephropathies has renal protective effects.23

Likewise, Cordyceps sinensis is extensively used by Chinese physicians to treat chronic renal diseases and to stimulate the immune system. It also displays anti-oxidative activities. It is commonly used in renal transplant patients; it has been shown to significantly improve renal fibrosis.24

Acupuncture and moxibustion

A recent single blinded randomized controlled study in patients with CKD showed that acupuncture at bilateral LI4, ST36 and KI3, and electroacupuncture to right ST36 and KI3 and left ST36 and KI3, once a week for 12 weeks, led to reduced creatinine levels and increased glomerular filtration rates.25 Moxibustion at Bl 23 in patients with CKD reduced renal vascular resistance.26

Most of the benefits that acupuncture offers in renal failure are undoubtedly due to the ability of these points to manipulate blood flow. Local blood flow is manipulated using BL23, BL22 and GB25, while systemic blood flow is manipulated with GB34, BL40 and KI3. Systemic blood flow greatly impacts renal function. Peripheral vasoconstriction can be induced to drive more blood to the kidneys. Peripheral vaso-relaxation can be induced to decongest the kidneys.

For animals in Stage II renal failure (using the IRIS classification system), and particularly where UPC ratios are greater than 2.5, use GB25, BL22 and GB34. These animals will typically have benefited from hypotensive drugs and low-protein diets, but won’t show an immediate improvement from fluid therapy. For animals in Stage I renal failure, or where UPC ratios are less than 2 to 2.5, use KI3, BL40 and BL23. These animals will typically not benefit from low-protein diets and hypotensive drugs, but will show an overt improvement from fluids.27

Integrative treatment goals for feline CKD

·         Mitigate oxidative stress by using antioxidant herbs

·         Improve renal perfusion (in most cases)

·         Prevent fibrosis, which is a natural consequence of renal disease

·         Optimise systemic health and well-being

Example of a low-phosphorus diet for cats with CKD

·         50 grams or ¼ cup pearl barley

·         200 grams raw chicken breast meat

·         10 grams chicken liver

·         1 large egg yolk

·         2 cups raw sweet potato

·         4 teaspoons salmon oil plus 4 teaspoons flaxseed oil

Cook barley, sweet potato, chicken and liver are on low heat with water. When warm, mix in egg yolk to lightly cook it (and preserve the choline). When cool, the recipe is divided into four meals (average 250 kcals) with the addition of 1 teaspoon of salmon oil and 1 teaspoon of flaxseed oil daily. The meals are divided.

The whole recipe provides 1,029 kcal, 36% carb, 40% fat, 24% protein and 724 mg of phosphorus. It needs to be supplemented as it is low in a number of minerals and vitamins, and is still low in choline. Any supplement added should be evaluated for its phosphorus content. This should demonstrate the complexity of balancing diets. Another excellent strategy is to have several recipes and vary the composition of diets over time. More protein can be utilised alongside phosphorus binders in later stages of kidney disease.

Conclusion

Chronic kidney disease in cats is a manageable condition that responds well to integrative medicine. In the author’s experience herbal medicine and acupuncture are key. Many integrative practitioners have reported success with other additional therapies, including homeopathy, cell salts, flower essences and osteopathy.

References

1Larsen JA. “Controversies in Veterinary Nephrology: Differing Viewpoints: Role of Dietary Protein in the Management of Feline Chronic Kidney Disease”. Vet Clin North Am Small Anim Pract. 2016 Nov;46(6):1095-8.

2Bangar OP, Jarald EE, Asghar S, Ahmad S. “Antidiabetic activity of a polyherbal formulation (Karnim Plus)[J]”. Int J Green Pharm, 2009, 3(3) : 211-214.

3Su ZZ, He YY, Chen G. “Clinical and experimental study on effects of man-shen-ling oral liquid in the treatment of 100 cases of chronic nephritis”. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1993;13(5): 259–260,269–272.

4Yi NY, Chu W, Koang NK. “Pharmacologic studies on Liu Wei Di Huang Wan: its action on kidney function and blood pressure of rats with renal hypertension”. Chin Med J-Peking. 1965;84(7):433–436.

5Yuan Y, Hou S, Lian T, Han Y. “Rehmannia glutinosa promotes the recovery of RBC and Hb levels in hemorrhagic anemia by promoting multiplication and differentiation of CFU-S and CFU-E bone marrow cell line”. Chung Kuo Chung Yao Tsa Chih. 1992;17(6):366–368.

6Lee BC, Choi JB, Cho HJ, Kim YS. “Rehmannia glutinosa ameliorates the progressive renal failure induced by 5/6 nephrectomy”. J Ethnopharmacol. 2009;122(1):131–135.

7Liu DG, Zeng M, Gao HY, et al. “Rehmanniae Radix and Rehmanniae Radix Praeparata Ameliorates Renal Interstitial Fibrosis Induced by Unilateral Ureteral Occlusion in Rats and Their Mechanism”. Zhong Yao Cai. 2015 Dec;38(12):2507-10.

8Zhou X1, Sun X1, Gong X1. “Astragaloside IV from Astragalus membranaceus ameliorates renal interstitial fibrosis by inhibiting inflammation via TLR4/NF-кB in vivo and in vitro”. Int Immunopharmacol. 2017 Jan;42:18-24.

9Shahzad M, Shabbir A, Wojcikowski K. “The Antioxidant Effects of Radix Astragali (Astragalus membranaceus and Related Species) in Protecting Tissues from Injury and Disease”. Curr Drug Targets. 2016;17(12):1331-40.

10Zhang HW1, Lin ZX, Xu C, et al. “Astragalus (a traditional Chinese medicine) for treating chronic kidney disease”. Cochrane Database Syst Rev. 2014 Oct 22;(10):CD008369.

11Shahzad M1, Small DM2, Morais C. “Protection against oxidative stress-induced apoptosis in kidney epithelium by Angelica and Astragalus”. J Ethnopharmacol. 2016 Feb 17;179:412-9.

12Zhang J1, Xie X, Li C, et al. “Systematic review of the renal protective effect of Astragalus membranaceus (root) on diabetic nephropathy in animal models”. J Ethnopharmacol. 2009 Nov 12;126(2):189-96.

13Fan YL, Xia JY, Jia DY. “Protective effect of Angelica sinensis polysaccharides on subacute renal damages induced by D-galactose in mice and its mechanism”. Zhongguo Zhong Yao Za Zhi. 2015 Nov;40(21):4229-33. [Article in Chinese].

14Song JY1, Meng LQ, Li XM. “Therapeutic application and prospect of Astragalus membranaceus and Angelica sinensis in treating renal microvascular lesions”. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Sep;28(9):859-61.[Article in Chinese].

15Wojcikowski K1, Wohlmuth H, Johnson DW. “Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy”. Phytother Res. 2010 Jun;24(6):875-84.

16Muthenna P1, Raghu G1, Kumar PA, et al. “Effect of cinnamon and its procyanidin-B2 enriched fraction on diabetic nephropathy in rats”. Chem Biol Interact. 2014 Oct 5;222:68-76.

17Mollazadeh H1, Hosseinzadeh H2. “Cinnamon effects on metabolic syndrome: a review based on its mechanisms”. Iran J Basic Med Sci. 2016 Dec;19(12):1258-1270.

18Kaffash Elahi R. “The effect of the cinnamon on dog’s heart performance by focus on Kortkoff sounds”. J Animal Veterinary. 2012;11:3604–3608.

19Dashti-Khavidaki S1, Shahbazi F, Khalili H, et al. “Potential renoprotective effects of silymarin against nephrotoxic drugs: a review of literature”. J Pharm Pharm Sci. 2012;15(1):112-23.

20Sedighifard Z1, Roghani F1, Bidram P, et al.  “Silymarin for the Prevention of Contrast-Induced Nephropathy: A Placebo-Controlled Clinical Trial”. Int J Prev Med. 2016 Jan 22;7:23.

21Sonnenbichler J, Scalera F, Sonnenbichler I, et al. “Stimulatory effects of silibinin and silicristin from the milk thistle Silybum marianum on kidney cells”. J Pharmacol Exp Ther. 1999 Sep; 290(3):1375-83.

22Wang XL1, Zhou FJ2, Dou M3, et al “Cochlearoids F-K: Phenolic meroterpenoids from the fungus Ganoderma cochlear and their renoprotective activity”. Bioorg Med Chem Lett. 2016 Nov 15;26(22):5507-5512.

23Joob B1, Wiwanitkit V2 Linzhi. “(Ganoderma lucidum); evidence of its clinical usefulness in renal diseases”. J Nephropharmacol. 2015 Dec 27;5(1):9-10.

24Du F1, Li S2, Wang T, et al. “Cordyceps sinensis attenuates renal fibrosis and suppresses BAG3 induction in obstructed rat kidney”. Am J Transl Res. 2015 May 15;7(5):932-40.

25Yu JS1,2,3, Ho CH4,5, Wang HY6,7, et al. “Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study”. J Altern Complement Med. 2017 Apr 19.

26Matsumoto-Miyazaki J1, Miyazaki N1, Murata I, et al “Traditional Thermal Therapy with Indirect Moxibustion Decreases Renal Arterial Resistive Index in Patients with Chronic Kidney Disease”. J Altern Complement Med. 2016 Apr;22(4):306-14.

27Marsden S. “Introduction to veterinary acupuncture course notes’> College Integrative Veterinary Therapies, 2017.

 

 

Cat Periodontal Disease

As seen in Petrax

Cat periodontal disease, or gum disease in cats, is an inflammation of some or all of a tooth’s deep supporting structures. It is one of the most common diseases in cats today.

 

If food particles and bacteria are allowed to accumulate along a cat’s gumline, it can form plaque, which, when combined with saliva and minerals, will transform into calculus (tartar). This causes gum irritation and leads to an inflammatory condition called gingivitis.

 

Gingivitis, which is evidenced by a reddening of the gums directly bordering the teeth, is considered to be an early stage of periodontal disease in cats.

 

After an extended period, the calculus eventually builds up under the gum and separates it from the teeth. Spaces will form under the teeth, fostering bacterial growth.

 

Once this happens, the cat has irreversible periodontal disease. This usually leads to bone loss, tissue destruction and infection in the cavities between the gum and teeth.

 

Symptoms and Types of Gum Disease in Cats

 

Periodontal disease in cats generally begins with the inflammation of one tooth, which may progress if not treated during different stages of the condition.

 

A cat with stage 1 periodontal disease in one or more of its teeth, for example, will exhibit gingivitis without any separation of the gum and tooth.

 

Stage 2 is characterized by a 25 percent attachment loss, while stage 3 involves a 25 to 30 percent attachment loss.

 

In stage 4 of cat periodontal disease, which is also called advanced periodontitis, there is more than a 50 percent attachment loss. In the most advanced stage of the disease, the gum tissue will usually recede and the roots of the teeth will be exposed.

 

Cats may also develop a cat gum disease called stomatitis (gingivostomatitis). Stomatitis is the severe inflammation of all of the gum tissue, which may affect the other tissues in the mouth.

 

Stomatitis occurs due to an overactive immune response to even small amounts of plaque and calculus.

 

Causes of Gum Disease in Cats

 

Cat periodontal disease can be caused by a variety of factors,  but is most commonly associated with bacterial infection. Bacteria under the gumline leads to pain and inflammation of the tissue.

 

There may also be a relationship between having a history of calicivirus infection and severe gingivitis.

 

Diagnosis of Periodontal Disease in Cats

 

In the exam room, your veterinarian will look inside your cat’s mouth for red, inflamed gums. That is the first indication of a problem. Your veterinarian may press gently on the gums to see if they bleed easily, which is a sign that a deep dental cleaning, or more, is needed.

 

Once under anesthesia, the diagnosis of cat periodontal disease involves a number of procedures. If periodontal probing reveals more than one millimeter of distance between the gingivitis-affected gum and tooth, a cat is considered to have some form of periodontal abnormality.

 

X-rays are extremely important in diagnosing periodontal disease in cats because up to 60 percent of the symptoms are hidden beneath the gumline.

 

In the disease’s early stages, X-rays will reveal loss of density and sharpness of the root socket (alveolar) margin. In more advanced stages, it will reveal loss of bone support around the root of the affected tooth.

 

Treatment

 

The specific treatment for cat periodontal disease depends on how advanced the disease is. In the early stages, treatment is focused on controlling plaque and preventing attachment loss.

 

This is achieved through daily brushing with pet-safe toothpaste, professional cleaning and polishing, and the prescribed application of fluoride or other pet prescription products to minimize the development of plaque.

 

Sometimes it is necessary to remove the teeth associated with severe stomatitis.

 

In the more advanced stages, bone-replacement procedures, periodontal splinting and guided tissue regeneration may become necessary.

 

Living and Management

 

Follow-up treatment for periodontal disease in cats consists mostly of maintaining good cat dental care and taking your cat for weekly, quarterly or biannual checks.

 

The prognosis will depend on how advanced the cat gum disease is, but the best way to minimize the adverse effects caused by the disease is to get an early diagnosis, adequate treatment and proper therapy.

 

Prevention

 

The best prevention for cat gum disease is to maintain your pet’s good oral hygiene and to regularly brush and clean her mouth and gums.

 

Cats can be trained to accept brushing when trained slowly over time and rewarded for their cooperation.

 

Prescription cat food dental diets are available for those cats who are unwilling to have their teeth brushed.

 

Cat dental treats, water additives and other products certified by the Veterinary Oral Health Council (VOHC) are also shown to help reduce plaque and calculus.

 

STROKES IN DOGS AND CATS

By W. Jean Dodds, DVM on March 24, 2019

With the untimely passing of actor Luke Perry, awareness of strokes came into the spotlight. Can dogs and cats have strokes? Yes; they can. Here’s what you need to know.

Types

Just like humans, dogs and cats can have one of two types of stroke: ischemic or hemmorhagic.

Ischemic
Ischemic strokes are caused by a blood clot, called a thrombus, which forms inside one of the brain’s arteries. The clot then blocks blood flow to a part of the brain. However, unlike humans, its typically only involve the smaller blood vessels in pets.

An embolism is a small blood clot (or piece of atherosclerotic plaque debris in people) that develops elsewhere in the body and then travels through the bloodstream to one of the blood vessels in the brain.

Hemorrhagic Stroke
There are two types of hemorrhagic strokes: intracerebral and subarachnoid.

An intracerebral hemorrhagic stroke occurs when a blood vessel inside the brain bursts and leaks blood into the surrounding brain tissue.

Subarachnoid strokes are typically caused by an aneurysm, which refers to a weakening of an artery wall that creates a bulge, or distention, of the artery. This type of stroke involves bleeding in the area between the brain and the tissue covering the brain, known as the subarachnoid space.

Signs

The symptoms or signs of strokes are similar in dogs and cats. They are rare and usually occur in geriatric pets.

Cats

·         Abnormal eye movements

·         Altered mental status

·         Circling

·         Head pressing

·         Head tilt

·         Muscle spasms

·         Not using the legs normally

·         Seizures

·         Unequal pupil sizes

·         Unsteadiness when walking

·         Weakness

Dogs

·         Abnormal behavior

·         Abnormal eye movements

·         Abnormal eye positioning

·         Blindness

·         Falling to one side

·         Head tilt

·         Inability to walk or walking with an uncoordinated gait

·         Loss of consciousness

Causes

Cats

·         Brain tumors

·         Cancer

·         Diabetes

·         Heart disease

·         High blood pressure

·         Hyperthyroidism

·         Kidney disease

·         Liver disease

·         Lung disease

·         Vestibular disease

Dogs

·         Bleeding disorders

·         Cancer

·         Cushing’s disease (hyperadrenocorticism)

·         Diabetes

·         Heart disease

·         High blood pressure

·         High and prolonged doses of steroids like prednisone

·         Hypothyroidism, severe

·         Kidney disease

·         Vestibular disease

Prevention

A stroke is usually caused by an underlying disease. The best preventative measure is to monitor the pet periodically in order to diagnose the disease before a stroke can occur. Disease diagnosis involves twice yearly check-ups in geriatrics and annually in younger pets , which includes routine blood, endocrine and urinalysis screening.

What to Do in the Event of a Stroke

If you think your companion dog or cat has suffered from a stroke, please take him or her to a veterinarian as soon as possible. As well, we recommend that you always keep the phone number and address of your area emergency veterinarian on hand for all pet related emergencies.

 

Arthritic Pets

Arthritis in Pets

By Dr. Karen Becker and comments by Diane Weinmann

Like humans, pets can and do develop osteoarthritis (OA), also known as degenerative joint disease (DJD). About 20 percent of dogs and cats of all ages suffer some degree of OA, including 1 in 4 dogs in the U.S.1,2 The risk increases with age, just as it does in humans. In fact, one study showed that more than 90 percent of kitties over the age of 10 have arthritis in at least one joint.3

Inflammation Is a Primary Source of Pain in Arthritic Pets

OA is a chronic inflammatory joint disease that causes pain, soreness, stiffness, swelling and lameness in pets. One of the most important ways we help dogs and cats with arthritis is managing their pain. As veterinary pain specialist Dr. Robin Downing explains it:

 “… [U]nmanaged (or undermanaged) pain leads us down a dark rabbit hole in which pain moves from a minor nuisance, to decreased quality of life, to unbearable suffering, and it can ultimately result in physical pathology that leads to death. In other words, it’s not an exaggeration to state that pain kills.”4

Inflammation is one of the pain-causing factors in arthritic pets, so decreasing it is of paramount importance in keeping your dog or cat comfortable and mobile. In addition, inflammation increases the risk for many other serious diseases, including insulin resistance and Type 2 diabetes, high blood pressure, heart and respiratory disease, cranial cruciate ligament (CCL) disease, kidney disease and decreased life expectancy.

Another disease associated with inflammation is cancer. Inflammation kills the cells of the body. It also surrounds cells with toxic inflammatory byproducts that inhibit the flow of oxygen, nutrients and waste products between cells and blood. This creates an environment in which abnormal cells proliferate.

Excess Fat Is a Primary Source of Inflammation

Unfortunately, most pets with arthritis are already, or become overweight, in part because they can no longer move around comfortably.

“The white fat that accumulates in overweight and obese patients secretes inflammatory and proinflammatory hormones that can enhance and amplify the chronic pain experience,” writes Downing. “For this reason, normalizing body composition — decreasing both the pet’s weight and the size of its fat compartment — is a critical component of any multimodal pain management strategy.”5

Downing makes the point that simply cutting back on the amount of food your pet eats isn’t enough, because while body mass will decrease, the fat compartment will remain (in proportion to the smaller body size). “In other words, a large marshmallow will simply become a smaller marshmallow,” she explains, which is why it’s necessary to feed a diet that allows the body to burn fat selectively for energy.

Veterinarian Dr. Ernie Ward, founder of the Association for Pet Obesity Prevention (APOP), calls excess fat an “adipokine storm” inside your dog’s or cat’s body:

“Adipokines are signal proteins produced by fat tissue,” says Ward. “Leptin, adiponectin and interleukin-6 (IL-6) are examples. We know adipokines cause or contribute to hundreds of harmful inflammatory processes throughout the body. Think of every fat cell as a little factory pumping out hundreds of potentially toxic compounds. Multiply that by millions or billions in an obese pet. The real danger of excess fat isn’t the fat; it’s the inflammation the fat causes.”6

Ward firmly believes inflammation is the biggest threat pets face today. Scientific evidence of the damage excessive inflammation causes to the body continues to mount.

I agree, and I think toxic fat combined with a toxic environment (lawn chemicals, flame retardants/PBDEs, vaccines, and flea and tick pesticides, to name just a few) plus malnutrition, courtesy of the processed pet food industry, is a 100 percent guarantee pets will suffer from at least one degenerative condition such as arthritis in their lifetime.

 

Processed Pet Food Is a Primary Source of Obesity in Dogs and Cats

Most integrative veterinarians, including me, believe processed diets are by far the biggest contributor to pet obesity. Most processed pet food isn’t biologically appropriate and contains exactly the types of ingredients that promote weight gain and inflammation in the body.

It’s also true that today’s dogs and cats are overfed and under-exercised, however, the first thing I scrutinize with any overweight patient is the type of food he’s eating. I look for things like the omega-6 to omega-3 ratio in the diet. Food high in omega-6 essential fatty acids and low in omega-3s (which is the case with most processed pet diets) is associated with inflammatory conditions.

Commercial pet food is also typically high in pro-inflammatory carbohydrates, including processed, high glycemic grains and starchy vegetables like potatoes or legumes, which contain lectins. If a pet is fed any dry food it’s a red flag, because all kibble contains some form of starch — it can’t be manufactured without it.

Arthritic Pets (and All Pets) Should Eat an Anti-Inflammatory Diet

All dogs and cats, especially those with inflammatory conditions such as arthritis, should be fed a moisture-rich, nutritionally balanced, species-appropriate diet that is naturally anti-inflammatory, consisting of real, whole foods, preferably raw, organic and non-GMO. It should include:

High-quality protein, including muscle meat, organs and bone (protein coming from animal sources should make up more than 80 percent of a cat’s diet)
Low to moderate levels of animal fat (depending on your pet’s activity level)
High levels of EPA and DHA (omega-3 essential fatty acids)
A few fresh cut, fibrous vegetables, pureed
No grains or starches
A whole food vitamin/mineral supplement that meets the additional E, zinc, iron, copper, manganese and vitamin D deficiencies often found in homemade diets OR enough of these hard-to-source foods in whole food forms, daily
Beneficial additions such as probiotics, digestive enzymes and super green foods

Along with a nutritionally balanced, species-appropriate diet, it’s important to practice portion control at every meal. For most pets, this means a carefully measured morning and evening meal. And don’t forget to factor in any calories from treats. You also need to know exactly how many calories your dog or cat should be eating per day. Use these calorie calculators to determine how many calories your pet should take in to lose weight or maintain his or her current weight.

Natural Supplements to Manage the Inflammation and Pain of Arthritis

Chondroprotective agents (CPAs) protect the joints and slow the rate of cartilage degeneration, and include glucosamine sulfate, collagen, MSM, eggshell membrane, perna mussel (green-lipped clam), Adequan and cetyl myristoleate.

Natural substances that can reduce or eliminate the need for painkillers in the early stages of arthritis include a high-quality omega-3 supplement (krill oil), ubiquinol, turmeric (or curcumin), supergreen foods (spirulina, astaxanthin), natural anti-inflammatory formulas (such as proteolytic enzymes and SOD), homeopathic remedies (Rhus tox, Bryonia and Arnica, for example), and Esterified Fatty Acid Complex (EFAC).

I have found CBD oil to be a very safe, long-term management strategy for chronic pain, and there are also Ayurvedic and Chinese herbs and nutraceuticals that can be very beneficial, depending on the animal’s specific symptoms.

Additional Beneficial Treatment Modalities for Arthritic Pets

Laser therapy Maintenance chiropractic
Assisi loop Underwater treadmill
Massage Acupuncture
Daily stretching

 

Dr. Becker recommends bringing your arthritic pet for a wellness checkup with your integrative veterinarian at least twice a year to review the status of her health, and to check the range of motion in her joints, the muscle mass she’s either gaining or losing, and to make adjustments to her protocol as necessary to ensure her quality of life is optimal.

Diane also recommends essential oils like Dr. Shelton’s New Mobility along with routine energy healing using healing touch for animals or reiki.  Diane has many clients that schedule weekly healing touch for animal distance sessions.   She has a cat client that she has been healing for years now and he is 21 years old!  Yeah energy healing!!!!

 

Hyperthyroidism in Cats

Hyperthyroidism in Cats

By Dr. Karen Becker

Recent research has revealed that yet another chemical substance found in households may be contributing to feline hyperthyroidism, a disease that affects a significant percentage of cats over the age of 10. The chemicals are called per- and polyfluoroalkyl substances (PFAS), and they are widely used as water and oil repellents. According to ScienceDaily:

“PFAS are a family of more than 3,000 structures of highly fluorinated chemicals used in industrial processes and consumer products, such as protective coatings for carpets, furniture and apparel, paper coatings, insecticide formulations, and other items.”1

PFAS are used in many industrial applications calling for nonstick or slick surfaces, such as food packaging, stain- and water-resistant fabrics, nonstick cookware and firefighting foam. These chemicals are now ubiquitous in our environment, having migrated into the air, household dust, food, soil, and ground, surface and drinking water.

Study Links PFAS Chemicals to Hyperthyroidism in Cats

For the study, a team of researchers at the California Environmental Protection Agency looked at blood levels of PFAS in two separate groups of Northern California kitties, most of which were at least 10 years old. The first group of 21 was evaluated between 2008 and 2010; the second group of 22 was sampled between 2012 and 2013.2

The researchers observed that the higher the blood levels of PFAS, the more likely the cat was to be hyperthyroid. One type of PFAS in particular, perfluorooctanoic acid (PFOA) was significantly higher in hyperthyroid kitties. These findings “… may indicate a possible link between PFAS levels and cat hyperthyroid, warranting a larger study for further investigation,” according to the research team.

In a bit of good news, the scientists noted a slight decline in PFAS blood levels between the first group of cats tested eight to 10 years ago, and the second group tested more recently. This mirrors recent results in humans as more companies phase out use of these chemicals, and presumably, as people gradually replace PFAS-treated household items.

Reducing Your Family’s and Pet’s Exposure to PFAS

Your best bet is to avoid all products that contain or were manufactured using PFAS, which will typically include products that are stain-resistant, waterproof or nonstick. From the Environmental Working Group:3

Find products that haven’t been pre-treated and skip optional stain-repellent treatment on new carpets and furniture
Cut back on fast food and greasy carryout food, since these foods often come in PFC-treated wrappers
Especially when buying outdoor gear, choose clothing that doesn’t carry Gore-Tex or Teflon tags, and be wary of all fabrics labeled stain- or water-repellent
Avoid nonstick pans and kitchen utensils — opt for stainless steel or cast iron instead
Pop popcorn the old-fashioned way, on the stovetop, since microwaveable popcorn bags are often coated with PFCs on the inside.
Choose personal care products without “PTFE” or “fluoro” ingredients; also avoid Oral-B Glide floss, which is made by Gore-Tex

It’s also important to filter your pet’s drinking water, and yours, to remove contaminants such as fluoride, chlorine, heavy metals and others. Household tap water typically contains enough toxic minerals, metals, chemicals and other unhealthy substances to damage your pet’s health long term.

Flame Retardants: Another Enemy of Indoor Kitties

Polybrominated diphenyl ethers (PBDEs), or flame retardants, are another type of household chemical that has been linked to overactive thyroid in cats, and a 2017 study confirmed the results of earlier studies that prove the high levels of PBDEs measured in indoor kitties are from house dust.4

PBDEs have been used since the 1970s in textiles, electronics and furniture to prevent them from burning, but like PFAS, they aren’t chemically bound to the product material, so they drift into the environment and cling to particles in the air such as house dust.

A number of these chemicals have been banned for use in household products, but they are extremely persistent and can leach into the environment for many years. Contaminated household dust can be inhaled as well as ingested, and can have an adverse effect on the health of kitties.

Brominated Flame Retardants Are Known Endocrine Disruptors

Prior studies of PBDE blood levels in cats have focused primarily on potential causes of feline hyperthyroidism, however, the intent of this study was to measure levels in healthy cats to establish their dust exposure.

The researchers took “paired samples” from the homes of each of the cats, meaning they took both dust samples and blood samples at the same time. They found evidence not only of brominated and chlorinated contaminants currently in use, but also chemicals that have been banned for decades. According to study co-author Jana Weiss, Ph.D.:

“By taking paired samples, we have greater insight into the environment that the cats live in. Moreover the cats in the study spent the majority of their time indoors and therefore air and dust in the home is expected to contribute more than the outdoor environment.”5

The study results are a heads up not only for cat guardians, but also anyone with small children, because both kitties and kiddos engage in a lot of “hand-to-mouth activities.”

“The brominated flame retardants that have been measured in cats are known endocrine disruptors. It’s particularly serious when small children ingest these substances because exposure during development can have consequences later in life, such as thyroid disease,” said Weiss.

Minimizing PDBE Exposure at Home

Most new foam products are not likely to have PBDEs added. If you have foam items in your home, office or vehicle that were purchased before 2005, however, they probably contain PBDEs. The Environmental Working Group offers the following tips to help limit your family’s and pet’s exposure to PBDE-containing products:6

Whenever possible choose PBDE-free electronics and furniture; PBDEs shouldn’t be in mattresses, couches and other foam products sold in 2005 or later, however they’re still put in some new televisions and computer monitors
Avoid contact with decaying or crumbling foam that might contain fire retardants, including older vehicle seats, upholstered furniture, foam mattress pads, carpet padding and kid’s products made of foam
Use a high-efficiency particulate air (HEPA) filter vacuum cleaner, since these vacuums capture the widest range of particles and are also good for reducing lead or allergens in house dust
Replace couches, stuffed chairs, automobile seats and the like that have exposed foam (if you can’t afford to replace them, cover them with sturdy cloth and vacuum around them frequently)
Don’t reupholster your older foam furniture, especially in homes where children or pregnant women live
Be careful when removing or replacing old carpet, since PBDEs are found in the foam padding beneath carpets; isolate the work area with plastics, and avoid tracking construction dust into the rest of your house
The replacement chemicals for PBDEs in foam are not fully tested for their health effects, so buy products made with natural fibers (like cotton and wool) that are naturally fire-resistant and may contain fewer chemicals

Did You Know PBDEs Are Also in Commercial Cat Food?

The same researchers who published the 2017 study I mentioned earlier also measured PBDE levels in cat food (both canned and kibble) matching the diets of the kitties in the study. They found that blood levels of PBDEs in the cats also significantly correlated with concentrations of those chemicals in the cat food.

In addition, another recent study concluded that fish-flavored cat food is a problem.7 A team of Japanese scientists evaluated cat food and feline blood samples and discovered that the type of polychlorinated biphenyl (PCB) and PBDE byproducts found in both the food and blood samples are derived from marine organisms.

The researchers were also able to simulate the way in which the bodies of cats convert the type of chemical present in the food into the type of chemical seen in the cats’ blood samples.

Based on their results, the team concluded the byproducts detected at high levels in cats’ blood samples likely came from fish-flavored food and not exposure to PCBs or PBDEs. However, further work is needed to determine the link between the metabolites (byproducts) and hyperthyroidism. If you’re wondering how these chemicals wind up in fish-flavored cat food, Dr. Jean Hofve of Little Big Cat explains it very well:

“There is a link between the feeding of fish-based cat foods and the development of hyperthyroidism, which is now at epidemic levels. New research suggests that cats are especially sensitive to PBDEs … [which are] found at higher levels in both canned and dry cat foods than dog foods; and more in dry than canned cat foods.

Fish-based foods are even worse, because marine organisms produce PDBEs naturally and can bioaccumulate up the food chain to high levels in fish; this compounds the exposure cats get from fabrics and dust.”8

5 Tips to Help Prevent Hyperthyroidism in Your Cat

  1. Rid your environment of flame-retardant chemicals
  2. Provide an organic pet bed
  3. Feed a nutritionally balanced, fresh, species-appropriate diet to control iodine levels in your cat’s food, since iodine has also been linked to hyperthyroidism
  4. Avoid feeding your cat a fish-based diet, since seafood is a very rich source of iodine, and cats aren’t designed to process a lot of iodine
  5. Avoid feeding soy products to your kitty, as they have also been linked to thyroid damage

I also recommend checking your cat’s thyroid levels annually after the age of 7.

 

Kidney Disease and your Cat

By Dr. Karen Shaw Becker and comments by Diane Weinmann

 

Feline expert Dr. Lisa Pierson, founder of the fabulous website CatInfo.org. Dr. Lisa graduated from the University of California, Davis veterinary school in 1984. For the last 15 years, she has focused almost exclusively on feline nutrition and feline medicine. Her passion is trying to help prevent some of the diseases we see in kitties today (e.g., diabetes and urethral obstructions) by feeding them properly.

“My biggest goal, as you well know,” says Dr. Lisa, “is to get people to stop feeding dry food to cats due to the water depletion, which can lead to urethral obstruction, and the carbohydrates, which make cats more susceptible to diabetes.”

Feline Kidney Disease May Be Linked to a Particular Vaccine

The no. 1 problem veterinarians see in cats today is kidney disease, and so I wanted to talk with Dr. Lisa about the best way to feed kitties with kidney disease. When I was in veterinary school 20 years ago, I was told 3 out of 4 cats will die of kidney disease. No reason was given. We were told, “There’s nothing you can do. Cats are predisposed to die of kidney failure.” We were taught how to identify the problem, but not what causes it. I asked Dr. Lisa for her thoughts on what’s behind the epidemic of kidney disease in cats.

“That’s a fabulous question I wish I had the answer to,” she replied. “We do know that a well-respected researcher, Dr. Michael Lappin at Colorado State University, has established a possible link between feline kidney disease and the feline viral rhinotracheitis, calicivirus and panleukopenia (FVRCP) vaccine, which is grown in feline kidney cell cultures.”

“We really want to be very careful not to over-vaccinate cats,” Dr. Pierson continued, “because they can possibly set up an autoimmune type of reaction to their own kidney cells. Having said that, my own cats still developed kidney disease.

I assure you they were not over-vaccinated. They got vaccinated as kittens. They passed away between 18 and 20 years of age. They were never vaccinated again after their kitten shots, yet they still got kidney disease. They were not on dry food. They were on a water-rich diet. So the short answer to your question is, ‘I don’t know, but I wish I did.'”

An important point to make here is that as Dr. Lisa’s situation demonstrates, we can do everything right and our cats may still acquire a debilitating disease, including kidney disease. Many parents of sick cats say, “I don’t know what I’ve done wrong.” Often, they’ve done nothing wrong. Even in optimal environments, cats can and do get sick.

How Many Vaccines Do Indoor-Only Cats Require?

I usually recommend, for people with indoor-only cats, that they skip all vaccines. If you know your cat will never step foot outside and no other cats will be brought into the home, there’s virtually no risk of exposure to the diseases we vaccinate against. I asked Dr. Lisa what she thinks about not vaccinating indoor-only cats at all.

“While I’m definitely against over-vaccinating, I always give at least one vaccine when the kitten is at least 16 weeks of age,” Dr. Lisa says. “I’ve seen enough cats die from panleukopenia to make me uncomfortable with the thought of no vaccines at all.

We do take these cats to veterinary clinics and many people do wear shoes in their homes so there is not zero exposure. I would at least vaccinate once. I differ with you on this issue. I’d be worried about leaving them completely unvaccinated for panleukopenia.

I had five cats two years ago. I lost four out of my five cats in the last two years. They were between 18 and 20 years of age. They received [two] FVRCP vaccines as kittens with the last dose administered when they were at least 16 weeks of age. A couple of them may have received another FVRCP vaccine a year later but no FVRCP vaccine was administered after that. None had been vaccinated since they were kittens or maybe a year old.

On their last day with me, I ran panleukopenia titers to measure the antibody levels in their bloodstream. Antibodies aren’t the only things that fight disease, of course, but for all intents and purposes, all the cats’ titers indicated they were protected against panleukopenia.

My mom’s cat is 20 years old. I don’t think I vaccinated him after age 5. I ran a couple of panleukopenia titers on him when he was 18 and again just recently and the titers were at a level that immunologists feel is a protective level against this disease.

My own cats are 100 percent indoor-only. They get vaccinated with FVRCP when they’re kittens, with the last vaccine at about 16 weeks of age when the maternal antibodies should be gone. I do not administer the FVRCP vaccine again.”

So Dr. Lisa does vaccinate her indoor-only cats, but minimally. Historically my indoor cats also received one vaccine at 16 weeks. But I think if I get another kitten who will live strictly indoors, I’ll probably not vaccinate at all. I’ll probably do none, since his or her exposure will be none, in my opinion.

‘Protein Is NOT the Enemy of the Cat Kidney!’

Next I asked Dr. Lisa for her thoughts on what cat parents can do early on in their pet’s life to try to prevent kidney disease.

“I really don’t know anything concrete,” she explained. “Some people believe a water-depleted diet of dry food can harm the kidneys, but I don’t know if there’s any research to support that theory.”

Often, cats fed exclusively dry food have super-concentrated urine because their kidneys are trying to preserve water for the body. “Does that cause or lend itself to kidney disease?” asks Dr. Lisa. “I really don’t know.”

“I feed a water-rich diet. I feed a species-appropriate highprotein/moderate fat/zero carb diet. With regard to how protein affects the kidneys, it’s important to understand protein is not the enemy of the cat kidney. Protein doesn’t cause kidney disease. It doesn’t exacerbate kidney disease. It is not the enemy of the kidney.

If there’s one take-home message I want to get across, it’s ‘Please stop vilifying protein!’ I would not feed any of the protein-restricted, so-called ‘prescription’ diets to any cat in my care. There are always better options.”

The Problem With Protein-Restricted Diets for Cats

Back in 1994, Dr. Delmar Finco proved cats will die of hypoproteinemia (insufficient protein) long before they die of kidney disease. I can’t figure out why, if we’ve had research available for over two decades, there’s still this pervasive idea in veterinary medicine that we should restrict protein. I asked Dr. Lisa why she thinks veterinarians still have not recognized that limiting protein is a really bad idea.

“We have to ask why this idea of protein-restricted diets came to be in the first place,” she replied. “Why did our profession glom onto the idea that protein is the bad guy? When we eat protein, our bodies break it down. We use what we need and our bodies produce BUN (blood urea nitrogen, or urea), which is a waste product of protein metabolism.

The more protein we eat, the higher the BUN load. If the kidneys are efficient and healthy, they filter the BUN out into the urine. When the kidneys become less efficient filtration organs, the BUN rises in the bloodstream. So the powers that be decided, ‘BUN comes from dietary protein. Let’s just minimize dietary protein.’

I do not have a problem with cutting back a little bit (say, from 60 or 70 percent to 40 percent) but I do not agree with feeding cats only 20 percent of their calories from protein.”

My thought is that if you’re feeding a poor-quality, rendered, dehydrated protein that conceivably consists of indigestible animal parts such as hooves and nails, it may negatively affect the kidneys long term. High-quality, human-grade, bioavailable protein — which is what cats in the wild eat — should have little to no negative impact on organ systems. If it did, felines wouldn’t have survived as a species.

However, we’ve preached the low-protein thing for so long, to switch viewpoints now could dramatically impact the billion-dollar pet food industry. I fear it’s possible we’ve gone too far to turn back.

“I’m still hopeful,” says Dr. Lisa. “I spoke with a colleague the other day. She had just attended a seminar at which someone said, ‘We’ve got to stop protein-starving these cats.’ And I thought to myself, ‘Hallelujah!’ I’ve been preaching this for 15 years, as have you.”

What Amount of Protein in a Cat’s Diet Is the Right Amount?

“I want to give your listeners some numbers to chew on,” says Dr. Lisa. “If you look at metabolizable energy, meaning the calories from protein, fat and carbs, they have to add up to 100 percent. Hill’s k/d, Purina NF, Royal Canin are prescription diets that restrict protein to a level between 20 [to] 27 percent of calories. A cat’s natural diet is about 60 to 70 percent.

When I formulate recipes for my chronic kidney disease (CKD) cats, or I recommend over-the-counter diets, using my proteins, fats, carbs, phosphorus chart at CatInfo.org, I recommend a nice happy medium of 40 percent calories from protein. I don’t think cats truly need the 60 to 70 percent they find in the wild. All you are doing is adding to the BUN load. I don’t think it’s necessary.

I’ve had fabulous results over the last 15 years feeding thousands of CKD cats right around 40 percent protein, and less than 10 percent carbs. My homemade diets have zero carbs. That means they have 60 percent fat, because it has to add up to 100 percent.

So those are some numbers I want to share with your listeners. In the vast majority of patients, I find that 40 percent protein calories will support muscle mass and the immune system without unnecessarily overloading the BUN bucket that the kidney then has to deal with.

Of course, more BUN is generated with a 40 percent protein diet than one with 20 percent protein. That is obvious. However, all disease processes are a trade-off and one has to remember a very basic equation: 6 ounces of a 20 percent protein diet = 3 ounces of a 40 percent protein diet in terms of grams of protein ingested — assuming the same caloric and water density.

Sure, a cat can meet their protein requirements on a diet that has only 20 percent of the calories from protein, IF they eat enough of it. But what happens when a cat on a protein-restricted diets starts to eat less? The answer is they will become protein malnourished and the diet needs to be more protein dense to make up for the decrease in volume intake.”

When You Lower the Protein in a Cat’s Diet, You Should Raise the Fat Content, Not the Carbohydrate Content

Interestingly, Dr. Lisa’s 60 percent fat figure lines up with the recommended fat intake in ketogenic diets. I think we need to educate pet parents that fat is an excellent source of energy, and it’s also dogs’ and cats’ evolutionary source of energy.

“In the wild, cats eat about 60 to 70 percent protein, 0 to 2 percent carbs, and then 10 to 30 or 40 percent fat,” says Dr. Lisa. “So the 60 percent fat for a CKD diet can end up being double what their natural diet is if we want to hold back on the protein a bit and NOT overload them with carbohydrates.

Research on fat content in cat diets indicates that some cats with GI problems such as chronic vomiting, chronic diarrhea, inflammatory bowel disease, and pancreatitis don’t do well on a 60 percent fat diet, but it’s rare.

Felines are obligate carnivores. They’re designed to eat protein, fat and no carbs. When pet food producers formulate prescription diets, k/d for example, with lower protein, they have to raise the percentage of either fat or carbs to get to 100 percent. Hill’s raises the carbohydrates, which makes the diet even more species-inappropriate.

Royal Canin actually chooses to raise the fat and keep the carbs down a bit. That’s much more species-appropriate. If you’re going to lower protein at all, don’t raise the carbohydrates. Raise the fat. Cats deal with fat more efficiently than carbohydrates.”

A Brilliant Tip for Monitoring Your Cat’s Kidney Function at Home

In my experience, many people with CKD cats are frustrated that the condition wasn’t discovered earlier. That’s why I like to be proactive and perform annual bloodwork to identify subtle changes that can occur in cats’ bodies long before they start showing symptoms of kidney dysfunction. I asked Dr. Lisa what she feels is the best age to start doing annual bloodwork on cats.

“That’s a great question, but I’m going to turn it around,” she replied. “What I check, because it’s usually the first thing to head south with respect to kidney disease, is urine specific gravity. I have a spoon sitting next to all my litterboxes — the boxes are uncovered because I’m not a fan of covered or hooded litterboxes — and a little syringe.

For around $50 to $70, you can buy a refractometer — this information is actually on my urinary tract diseases page towards the bottom under the video showing how to obtain a free-catch urine sample at home. There’s a link there to a refractometer. I put a couple of drops of urine from the syringe on it and look at urine specific gravity, which is a measure of the concentrating ability of the kidneys.

All my cats go in for annual bloodwork anyway, no matter their age. Of course, if they’re sick, I’ll take them in more frequently. Bottom line is, I do annual bloodwork, but I’m checking their urine specific gravity frequently ([four to six] times a year) when they get to be 10 years of age or if I notice them drinking more than usual. My cats are very used to spoons stuck under their butt!

The SDMA test — which is the proprietary IDEXX urine test that is supposedly better than creatinine levels in detecting early kidney disease — can also be run. However, measuring urine specific gravity can be done at home for no cost other than a refractometer and it may be even better than the SDMA, in some cases, to help us recognize kidney disease earlier.

Urine specific gravity parameters:1.040 and above shows a normal urine concentrating ability of the kidneys; 1.012 is rock bottom. When you start getting 1.030, 1.025, 1.020, you may want to take your cat in to check the BUN, the creatinine, the phosphorus and the potassium.”

That’s really great advice. Cheap, easy, and you’re not stressing out your cat. Just follow kitty with your spoon when he goes into his litterbox, stick spoon under butt, collect a bit of urine, pull it into your syringe and put a couple drops in your refractometer. You can start when he’s a kitten, or as soon as you bring a new adult cat home. You can continue to do it proactively throughout their lives. It’s a brilliant tip!

The Kidney Disease Staging System (IRIS) Has Serious Flaws

“I also suggest setting up an Excel spreadsheet for all the BUN, creatinine, phosphorus, potassium and urine specific gravity results,” Dr. Lisa continues. “Those are my big five: BUN, creatinine, phosphorus, potassium and urine specific gravity. I’ve charted all my cats, which brings me to the IRIS staging system.

The IRIS staging system — IRIS stands for International Renal Interest Society — establishes parameters for judging the severity of kidney disease. When the creatinine is over X, they’re stage one. When it’s over Y, they’re stage two. There are four stages.

I personally strongly dislike this system. I think it’s far too strict. Creatinine over 1.6 is deemed a problem. I disagree with that. My own cat, Robbie, has had a creatinine in the low [2s] for the past 10 years.

He’s 17 years of age, and his kidneys are still fine. I think the IRIS staging system alarms people unnecessarily, and too early. I think it’s too strict. I just want readers and your listeners to understand that when your vet says stage 1 kidney failure it’s a case of maybe, or maybe not.”

This is very true. There’s a whole lot of doom and gloom around IRIS staging. I think it can actually lead to premature euthanasia, when the fact is there is much that can be done for these cats, sometimes for years to come.

“The cats are put on a prescription renal diet, which I strongly dislike,” says Dr. Lisa. “It’s also one of the reasons I have a problem with the SDMA test, because these cats are being put on protein-restricted diets even earlier. I think to myself, ‘Great. We’ve got an early marker, but now these 6-, 7-, 8-year-old cats are being put on protein-restricted diets, which makes me cringe.'”

Why Supplementing With Fish Oil/Omega-3s Is so Important

So let’s say we have a cat for which we regularly check urine specific gravity, and all is well until kitty turns 9 or 10 and his number dips to, say, 1.025. We take him in for an SDMA test, and the vet determines he’s in the beginning stages of renal disease. I asked Dr. Lisa how she would proceed at that point.

“First of all, let’s hope the cat has been off of dry food all his life, or at least as soon as his owner learned dry food is not a very healthy diet for a cat,” she says. “So let’s hope he’s on a water-rich diet.

Regarding urine specific gravity: Picture a sieve in your kitchen, and the holes of that sieve are getting bigger and bigger and bigger. When urine specific gravity drops, it means the kidneys are leaking more and more water. They’re unable to save water for the body.

There’s nothing that frustrates me more than to see cat owners leave their vet’s office with a bag of fluids under one arm and a bag of dry food under the other arm. They’ve been told to feed a water-depleted diet and then stick a needle in their cat’s back to put water into him. That’s pretty nonsensical

The sensible approach? Step one, provide a water-rich diet. Step two, the diet should be low in phosphorus. Step three, supplement with omega-3 fatty acids— fish oil, fish oil, fish oil. When we do post-mortems on these cats, we see nephritis. ‘Neph-‘ means kidney, ‘-itis’ means inflammation.

We know that fish oil and omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA), are anti-inflammatory. There was a meta-data study done that looked back at all the individual CKD studies that were done, and the researchers discovered that cats getting high amounts of fish oil seemed to live the longest.

Now, I’m not that bright, but two plus two might equal four in this case, where we have an inflammatory process. Fish oil happens to have anti-inflammatory properties, so it stands to reason that fish oil may slow the progression of kidney disease.

Here’s my goal: one capsule per cat per day. One regular strength capsule should have about 300 milligrams of combined EPA plus DHA. They’ve done safety studies to show that 600 milligrams of combined EPA plus DHA per cat per day is safe.

Fish oil can cause bleeding problems in some patients, which is why if you’ve gone in for surgery in recent years you’ve probably been told to stop taking aspirin and also fish oil ahead of time because they have anti-clotting properties. But 300 milligrams of combined EPA plus DHA is safe.”

“We also treat with potassium as needed,” explains Dr. Lisa, “because sometimes these cats get very hypokalemic, meaning they have low blood potassium levels.

One of the reasons I don’t like the prescription renal diets is because toward the end stage, CKD cats can get hyperkalemic, meaning they have too much potassium in the blood. All the renal diets are fortified with potassium, so they end up compounding the problem of hyperkalemia and are detrimental to the patient.”

Switching a Dry Food-Addicted Cat to a Moisture-Rich Diet

“I really love homemade diets,” says Dr. Lisa. “I’m a big fan. The recipes I formulate mimic the prescription diets in that they include plenty of B vitamins and antioxidants, plenty of fish oil, and I can adjust the potassium as needed based on the patient’s blood levels.

They’re low in phosphorus. They contain a moderate amount of high-quality proteins versus the prescription diets, [which] are more protein-restricted and often have very [poor-quality] (low biological value) sources of protein (e.g., [Brewers’] rice). My patients thrive on these homemade diets.”

I’m of course a huge proponent of homemade diets as well. The number one complaint I get from clients, though, is their cat won’t it eat.

“First of all, there is no need to make diet ‘all or nothing,'” says Dr. Lisa. “Many cats will not eat a diet of 100 percent homemade and always need a bit of commercial canned food mixed in to make it more flavorful. It’s fine to mix commercial with homemade. Some homemade is better than nothing.

That said, I find that people give up far too easily when trying to get their cats to eat a new diet. People shouldn’t get discouraged as quickly as they do. They have to roll up their sleeves, work at it, and be patient. Also, the key issue is change the diet before your cat is really sick. No sick cat wants to try something new.

And use your cat’s hunger as your friend. Don’t put the food down, watch them walk away from it, and just give up by putting their old food back down. Make them go 12 hours without food. Make them go 18 hours without food. Get a little tough.

Look at my tips for transitioning a dry food addict. It’s applicable when you need to change any diet. Hunger is your friend, number one. Take the diet they like, 90 percent of it. Mix in 10 percent homemade, then go 80-20 or 70-30. Or do the opposite, take 90 percent of the homemade, start slipping in a little Fancy Feast or Sheba, or whatever you want to feed.

But be patient. Don’t give up. You can actually out-stubborn your cat, but people give up far too easily. It took me three months to get my cats off 100 percent dry food. Some of them had never seen canned food in their entire lives, including my 10-year-old. It took me three months to get them from dry food to canned food.

And then it took me a little bit longer to get them from the canned to the homemade, because the canned tends to be gamier-smelling, and probably a little bit more flavorful.

I love FortiFlora, which is a Purina probiotic. I use it as a flavor enhancer, not as a probiotic. If I were to put that powder on cardboard my cats would eat it! I just use it like salt and pepper, just sprinkle it on their meals. It’s a liver digest. If you’re going to pick something that a cat likes, most cats love liver.

Or you can buy something like Fancy Feast Chicken and Liver or Turkey and Liver, the classic feast, which is kind of my go-to enticement. I try to stay away from fish. I don’t want to create a fish addict. There are other problems with fish. But when you’re trying to transition a cat away from dry food, I don’t mind giving them a little bit of fish, but you’ll have to wean them off it.”

A Word About Fish Versus Fish Oil

For those of you confused as to why we’re recommending fish oil but not fish, I should clarify that our issue with fish as a protein source is that not only are many types of fish contaminated, they are also high in iodine, which can cause hyperthyroidism. Good-quality fish oil supplements don’t contain iodine and are tested for purity and potency, which means they’re screened for heavy metals and PCBs.

Fish oil also doesn’t cause food sensitivities, unlike fish fed as a protein source. Bottom line, fish oil is really in an entirely different category from fish fed as a protein source. It’s protein versus fat, as Dr. Lisa points out. Fish oil is safe and a good source of omega-3 essential fatty acids. However, feeding fish to cats is not recommended.

If Your Cat Has Kidney Disease, Ask Your Vet About Calcitriol

I asked Dr. Lisa what else she would suggest cat parents do to help enhance their kitty’s quality of life, longevity and kidney function.

“You might want to ask your veterinarian about calcitriol,” she answered. “Calcitriol is the active form of vitamin D. One of the jobs of the kidneys is to take the inactive form of vitamin D and activate it. In other words, it makes calcitriol.

The parathyroid gland, not the thyroid gland, but the parathyroid gland, is very intimately involved with calcium and phosphorus balance. It secretes parathyroid hormones (PTH), which can be toxic to the kidneys if it gets too elevated. The off switch for PTH production is calcitriol.

If we don’t have enough calcitriol in our body, there’s nothing to tell the parathyroid gland, ‘Shut up. Be quiet. Stop making so much PTH.’ The research on cats is scant and a little iffy. But calcitriol proved to be beneficial in a study of dogs.

There are some feline specialists who are big proponents of calcitriol for cats, and I personally think it’s a ‘can’t hurt, may help’ issue. Your viewers should ask their vets about administering calcitriol to their CKD cats. It’s recommended early in the disease. If the dosage is adhered to properly, I think it’s a can’t-hurt-may-help.

When we first tried the calcitriol we got some hypercalcemia early on because we were giving it every day and at higher doses than we currently use. We now give it twice a week instead. And for the record, I don’t recheck CKD patients to death. I feed a high[-]quality, low-phosphorus diet with plenty of antioxidants and anti-inflammatories. I use calcitriol and call it a day. Beyond that, the chips are going to fall where they may.

I find that most of my clients get frantic, asking ‘What can I do, what can I do, what can I do?’ The truth is, not much. Cats’ kidney disease will progress as it’s going to progress. So again, don’t over-vaccinate. Feed a water-rich diet. Sit back and relax with your cat. Don’t keep fretting about it because the kidneys are going to do what they’re going to do on their own timetable. There’s really nothing we can do about it beyond the basics I’ve just discussed.”

If Your Cat Is Diagnosed With Kidney Disease, There’s No Need to Panic

I am always impressed with how resilient cats’ bodies are. Even in a state of decompensation (organ failure) they keep going and going and going. Often the BUN is very high and they’re still eating and physically look fine. If we’re chasing a number or making decisions based on a lab result, I think it’s easy to become so overwhelmed that it takes away from our quality of life. It’s possible to fret so much about the future that we don’t enjoy the time we have left with our pet.

“I’m glad you brought that up,” says Dr. Lisa. “I find that subcutaneous fluids are used far too early in the disease process. I’m also not a fan of Azodyl. I don’t feel it works. I don’t feel there’s any benefit. I don’t want to see cats being pilled with these humongous capsules.

You know me, I’m typically not much of a supplement person. I’m a ‘Give them good food, give them fresh water, love them and don’t keep poking a needle in their back until it’s really time’ sort of person.”

Dr. Lisa brings up a great point. I love Azodyl, but I do not believe we should be shoving anything down a cat’s throat. I think if your kitties will eat supplements like Azodyl or probiotics on their own, awesome. But the last thing you want to do is chase a cat, especially a sick cat around the house and have her hide under the bed and fear you.

This is completely disruptive to your relationship with your kitty, and even more important, it significantly increases her stress response, which will end her life sooner than anything else. There’s no reason we should be cramming anything down a cat’s throat. If they take supplements voluntarily, great. If they don’t, don’t force it.

“Absolutely,” says Dr. Lisa. “I have an article on pilling cats on my website. I hate pilling cats. I may be a real weeny about it, but I just hate it. And again, be careful about starting fluids too early. Cats can live a long time with CKD.

My cats got kidney disease at 14 and 16. They both died four years later, but not from kidney disease. They died from cancer. And I want to also mention that just because your cat has a low urine specific gravity, it isn’t the kiss of death. Cats whose kidneys have stopped fully concentrating the urine can live three, four, five years and longer and quite often die from something else. If your cat starts to get a low urine specific gravity number, there’s no reason to panic.”

Honoring Your Sick Cat’s Wishes

All of Dr. Lisa’s suggestions today have been common sense and very respectful of the feline body and spirit. But I think, most importantly, they should provide peace of mind for those of you watching or reading who are worried about your cat and kidney disease.

Sometimes the more information we gather — even though we want to understand everything we can so we can make good decisions — can create profound stress. It can also cause vets to give their clients with CKD cats long lists of tasks to perform that can be daunting. Often, we’re making decisions not on how the cat looks or seems to feel, but on a theoretical disease progression that may or may not occur. We end up creating stress for everyone in the family, including the cat, and it doesn’t have to be that way.

“Exactly,” Dr. Lisa says. “When I go on VIN (the Veterinary Information Network), colleagues are asking each other questions like, ‘When do you start fluids?’ The answer more often than not is something like, ‘When the creatinine is 3,’ which is a very arbitrary approach to a procedure that is stressful for both the cat and the owner.

Instead, you need to look at the patient. Are they eating a water-rich diet? Are they eating plenty of it? Do they have any vomiting or diarrhea? Are they bright and alert? You don’t just start fluids arbitrarily at a number. You look at the patient.

It’s also important to understand that plain water (no sodium, chloride, etc.) taken in orally is healthier for a body then the fluids that are administered subcutaneously. Therefore, we should do whatever we can to increase oral water intake before starting sub Q fluids. This means feeding no dry food and adding some extra water to canned food or a homemade diet.”

I think if an animal is saying, “Don’t do that to me,” we need to not do it to them. That’s one of the hardest things to convince clients of, that “This will be a really nice approach IF our patient participates.” But if we have a cat who chooses not to participate, we need to respect that. I think we need to encourage our clients to be more respectful and push less. “I agree 100 percent,” says Dr. Lisa. “My Toby, I thought he’d be very easy to give fluids to. I tried it, and he hated it, so I didn’t force him to accept the procedure.”

Sometimes we end up making decisions to not treat the patient, because they have decided they don’t want to be treated. That’s called honoring our patients’ wishes. To honor their wishes, why not ask your cat?  Contact an animal communicator like Diane Weinmann at dianefortheloveofanimals@yahoo.com to discover your cat’s wishes.

“Quality over quantity,” Dr. Lisa agrees. “Because let’s face it, we want everybody, human and animal, to live forever. There’s a selfish component to it, because you don’t want to lose them. But don’t be selfish with your cats. Listen to them.”

I very much appreciate Dr. Lisa Pierson making time for me today and sharing her tips, tricks, ideas, thoughts and amazing information with us. Be sure to visit her website, CatInfo.org, which provides a wealth of extremely helpful and practical information about your cat’s health.

 

Here’s the Scoop on Cat Poop

Here’s the Scoop on Cat Poop

 By Cheryl Lock

While most cat owners are on the lookout for litter box problems, they may not be paying close enough attention to what’s going on inside the box. As unappealing as it may sound, keeping an eye on your cat’s poop can provide an important window into his health.

By knowing what a healthy bowel movement is supposed to look like, you can notice when something isn’t quite right with your kitty, and figure out what to do about it.

What Cat Poop Reveals About Overall Health

Just like for humans, your cat’s feces can be a predictor of important things going on inside his body. For example, a cat with abnormal feces may be suffering from a digestive disorder or liver or kidney disease, says Dr. Alan Schwartz of Compassion Veterinary Health Center in Poughkeepsie, New York. “In a relatively normal cat, [problems with bowel movements] can also be a sign of a sensitivity to the diet offered, as well as parasites,” he adds.

Many times, when cats start to show signs of kidney disease, they become dehydrated, which causes them to have hard stools, says Dr. M. Duffy Jones of Peachtree Hills Animal Hospital in Atlanta, Georgia. “This can lead to constipation, but also should tip you off to get some blood work run to see if there is early kidney disease.” Of course, constipation can have other causes as well, including anything else that leads to dehydration, intestinal blockages, dirty litter boxes, inactivity, neurologic disorders, painful defecation, and the use of some types of drugs.

Diarrhea can also indicate intestinal upset and inflammation, Jones adds, so it’s important to get it checked out. “It can be caused by anything from worms to things stuck in the intestines,” and many other potential problems, he says.

abrupt change in your cat’s diet will almost always cause a change in stool, Schwartz says. Diet changes can temporarily affect the smell, color, and quality of your cat’s poop, notes Dr. Mark Waldrop of the Nashville Cat Clinic. If your cat is otherwise healthy, however, these symptoms should resolve within three to five days. “While your cat’s feces will never smell like roses, a notable worsening in smell should be evaluated, as it can be a symptom of intestinal disease,” Waldrop stresses.

Frequency of Your Cat’s Bowel Movements

 

“Cats are all different as far as regularity, but most will have once daily bowel movements,” Schwartz says.

As cats age, however, they may have less frequent bowel movements, Waldrop says. “You may even see times when they skip a day.”

But if your cat goes more than two days without stool production, it’s best to call your vet. When cats are constipated, “they will strain or take an inordinately long time in the box, or frequent the box with no stool produced,” Schwartz says.

On the other hand, too much stool can also indicate something is wrong. If your cat consistently has more than two bowel movements a day, you should consult with your vet, Waldrop says.

Color of Your Cat’s Poop

Under normal circumstances, a cat’s stool is dark brown, Waldrop says. “Black is consistent with digested blood in the stool, especially if it’s shiny and looks like road tar,” he describes. Tan or light brown can be an indication of liver or pancreatic issues, he says, but diets high in fiber will also produce a lighter-colored stool.

If you notice blood in your pet’s stool, make an appointment to see your veterinarian, Schwartz advises, as that can be a sign of a potentially serious problem and provide a route for bacteria to enter your cat’s bloodstream.

Pet parents should also call their vet if they notice mucus in the stool. Your cat’s poop should not have any coating, Waldrop adds. “If you find coating on the stool, it could be an indication of colitis.”

Consistency of Your Cat’s Poop

To know what loose or hard stool looks like, you’ll first need to know what regular, healthy stool looks like. The ideal stool should be firm (but not rock hard) and shaped like a log, a nugget, or a combination of the two, Waldrop says.

 

Keep in mind that the ancestors of domestic cats were desert dwelling creatures. As such, their colons are very effective at removing moisture from the stool, which means it’s normal for their stool to be firm, Waldrop says. “I have a lot of clients bring in normal stool for analysis thinking their cat is constipated,” he says.

Anything that is not formed (i.e., soupy or soft stool) is considered diarrhea, Waldrop says. “Whether it’s liquid or pasty, it’s abnormal and should be evaluated.”

Schwartz notes that it’s important to keep an eye on the consistency of your cat’s stools, especially since cats are prone to inflammatory bowel disease, which is a relatively common cause of diarrhea.

Content of Your Cat’s Poop

“Hair is the most common item noticed in stool, and if it’s not excessive, then this is totally normal,” Waldrop says. If you find large amounts of hair in your cat’s poop, it can be an indication that the cat is over-grooming, he explains, which can be associated with anxiety, itchy skin, or diseases causing excessive shedding.

Tapeworms may also be seen in your cat’s poop, Waldrop says. “They are shiny, white, and about the size of rice,” he describes. “They may also be moving.” Most other intestinal parasites are not visible in the feces.

Other things to watch out for include pieces of cat toys or other household items, such as thread or dental floss. “Some cats are chewers, and if you see these kinds of things in your cat’s stool, you will really need to keep those items out of your cat’s reach, as they can potentially lead to an obstruction,” Waldrop says.

If you notice any of these objects in your cat’s stool, make an appointment with your veterinarian.

What to Do About Cat Poop Issues

As a rule of thumb, never try a home remedy for your cat’s poop issues—or for any malady—without first checking in with your veterinarian, Schwartz says. “Cats are very particular with their sensitivity and tolerance to over-the-counter medicines,” he says.

In addition, it’s always important to make sure your cat has access to fresh water and is drinking enough of it, he says. “Elderly cats are commonly dehydrated because they tend to drink less,” and are prone to diseases that increase their water intake needs.

Jones reminds pet parents to relate their cat’s stools with how the cat is acting. “If your cat is lethargic and the stools change, that is cause for concern,” he says. “If the cat is normal and the stools change, normally I will give them a little time and look for other clinical signs of disease.”