How to Measure Your Cat’s Pain Just by Looking at Her Face

How to Measure Your Cat’s Pain Just by Looking at Her Face

By Dr. Karen Becker

 

When it comes to determining if your cat is in pain, the struggle is real — for both of you. As almost any cat parent can tell you, our feline friends are masterful at keeping their illnesses, aches and pains hidden from us.

This is by design, because while cats in the wild are accomplished hunters, smaller wildcats are also prey for larger animals. Showing illness, pain, or any vulnerability in that setting invites predation. That’s why your cat, and all cats, are wired to appear “normal” while dealing with significant illness or discomfort.

To complicate things further, since kitties tend to hide or keep to themselves when they’re not feeling well, it’s easy to misinterpret or simply overlook signs your furry family member is hurting.

The good news is that researchers are hard at work trying to solve this frustrating puzzle by developing tools both veterinarians and pet parents can use to decipher the body postures and behaviors most commonly seen in painful cats.

Interpreting Changes in Feline Facial Expressions as a Measure of Pain

A brand-new pain measurement tool for use with cats is the Feline Grimace Scale (FGS), which was recently validated, and the results published in the journal Scientific Reports.1

To develop the scale, researchers at the University of Montreal conducted an observational, case-control study of 31 privately owned cats in pain and 20 pain-free control cats. The kitties were videotaped undisturbed in their cages, and the researchers assessed their facial expressions using screenshots from the videos.

Next, two observers independently compared screenshots of the two groups of cats (painful and pain-free) to evaluate differences in facial expressions. The researchers then categorized, tested, and scored five “facial action units” (ears, eyes, muzzle, whiskers, head) that signal pain in cats:2

  • Ear position — Ears facing forward, ears slightly pulled apart, or ears flattened and rotated outward
  • Orbital tightening — Eyes opened, eyes partially opened, or eyes squinted
  • Muzzle tension — Muzzle relaxed (round), muzzle mildly tense, or muzzle tense (elliptical)
  • Whisker position — Whiskers loose and curved, whiskers slightly curved or straight, or whiskers straight and moving forward
  • Head position — Head above the shoulder line, head aligned with the shoulder line, or head below the shoulder line or tilted

Each facial action unit receives a score of 0, 1, or 2. A score of 0 indicates absence of pain in the facial action unit, 1 is moderate appearance of pain or uncertainty, and 2 is obvious appearance of pain. The maximum total score is 10; a total score of 4 or more means the cat is in pain and needs analgesia. You can see images of cats in which pain was absent, moderately present, or markedly present here.

The FGS was designed primarily for use by veterinarians, but the developers are working to validate its use with other veterinary care professionals as well as pet parents.

Your Cat’s Behavior Is Also a Window to His Pain

A 2016 study headed up by researchers at the School of Life Sciences at the University of Lincoln in the U.K. investigated signs of pain in cats.3 Signs of feline pain are primarily behavior-related, which is why I always encourage cat guardians to observe kitty’s behavior for signs of a problem.

The U.K. researchers surveyed an international panel of 19 veterinary experts across a variety of disciplines. The experts were first asked to list disorders they considered to be consistently, inherently painful in cats. Next, they were asked to evaluate pain-related behavior in cats according to the following criteria:

  • Presence of the behavior in acute and/or chronic conditions and/or conditions not known to be painful
  • Reliability of the behavior as an indicator of pain
  • The likelihood the behavior would be present in a cat who is experiencing a low level of pain
  • The likelihood the behavior would be present in a cat who is experiencing a high level of pain

Based on survey results, the researchers identified 25 signs considered sufficient to indicate pain. However, no single sign of the 25 was considered necessary for a cat to actually be in pain.

25 Signs Your Cat Is Hurting

The 25 behavioral signs considered by veterinary experts to be reliable and sensitive for the assessment of pain in cats, across a range of different clinical conditions” are:

Lameness Hunched-up posture
Difficulty jumping Shifting of weight
Abnormal gait Licking a particular body region
Reluctance to move Lower head posture
Reaction to palpation Blepharospasm (eyelid contraction)
Withdrawn or hiding Change in form of feeding behavior
Absence of grooming Avoiding bright areas
Playing less Growling
Appetite decrease Groaning
Overall activity decrease Eyes closed
Less rubbing toward people Straining to urinate
General mood Tail flicking
Temperament

The researchers concluded:

“These results improve our knowledge of this topic, but further studies are necessary in order to evaluate their validity and clinical feasibility (especially in relation to different intensities of pain) to help vets and caregivers of cats recognize pain in this species effectively and as early as possible to maximise cat welfare.”

Another Pain Measurement Tool: The Feline Musculoskeletal Pain Index

Cats suspected of suffering with musculoskeletal pain are much easier to evaluate in their own homes vs. a veterinary clinic, because they’re less stressed and more likely to move around. The Feline Musculoskeletal Pain Index (FMPI) is designed to be used not only by veterinary staff, but more importantly, by cat owners.

“Using language accessible to cat owners, the questionnaire asks a series of simple questions about movement, behavior, sleep and mood,” writes feline practitioner Dr. Elizabeth Colleran.

“Pain associated with bones, joints and muscles results in compensatory behavior alterations that can be seen by a caregiver who’s known the cat for a period of time. A score is attached to the completed form which is used to evaluate the degree to which the cat has changed over time.”4

If you’re interested in the FMPI, visit PainFreeCats.org. The questionnaire can be downloaded or filled out online and repeated over time to see how your cat is progressing. It’s also important to discuss the results with your veterinarian. Since your cat’s health will naturally change over his lifetime, the FMPI can help you track trends, identify patterns of behavior, and make adjustments to his treatment protocol as necessary.

The Importance of Managing Your Cat’s Pain

As your kitty’s primary advocate, it’s important to realize that pain is a serious medical problem requiring treatment. Chronic pain can cause inactivity and loss of overall quality of life. It can also damage the bond you share with your cat if her personality or behavior changes or she becomes aggressive.

In addition, when pain isn’t managed effectively, it can progress from what we call adaptive pain — pain caused by a specific injury or condition — to pain that is maladaptive. Maladaptive pain can be of much longer duration than normal pain and considerably more challenging to treat. One of the best ways to avoid “pain wind up” from the beginning is to effectively address pain immediately.

I regularly see clients who are fearful of using appropriate pain drugs immediately after surgery (usually Buprenorphine) and opt instead for natural support. In my opinion, even the most potent herbs and nutraceuticals won’t address moderate to profound pain to the degree necessary to be considered humane, post-surgery.

After the patient’s pain is well managed on appropriate pharmaceuticals, the vast majority of cats can be weaned onto all-natural protocols (or a blended protocol including a reduced amount of pain killers) that do a great job of handling mild to moderate pain.

Alternative Approaches to Pain Management

Since felines are physiologically very unique, there are few effective pharmacologic agents that can be safely given long-term to control the pain of chronic conditions like arthritis.

Fortunately, there are a number of alternative therapies that can alleviate your kitty’s pain naturally, including chiropractic, therapeutic massage, stretching exercises, acupuncture, laser therapy, and the Assisi loop, which is a form of pulsed electromagnetic field therapy.

There are supplements that can be added to an arthritic cat’s diet to provide the raw materials for cartilage repair and maintenance and slow down progression of the disease. These include glucosamine sulfate, methylsulfonyl­me­thane (MSM), and eggshell membrane.

If your cat is overweight, it’s important to safely diet her down to a healthy weight to decrease the amount of inflammation in her body, since inflammation is a primary feature in all types of pain. It’s also important to feed an anti-inflammatory diet, which means eliminating pro-inflammatory foods that create inflammation and make the pain cycle worse.

Eliminate all grains in your cat’s diet, as well as foods in the nightshade family, such as potatoes, which are found in most grain-free cat foods. Grain-free processed diets aren’t carbohydrate-free, and carbs create an inflammatory response in cats.

Homeopathic remedies and nutraceuticals often work wonders for cats dealing with chronic pain, as does cannabidiol (CBD) oil. Many kitties also tolerate turmeric and omega-3 fatty acids, Esterified Fatty Acid Complex (EFAC), as well as boswellia added to their food, all of which help naturally reduce inflammation.

I recommend working with a integrative veterinarian to determine how to best treat chronic pain conditions in cats.

How to Create Quality Pet Time, Even if You’re Crazy Busy

How to Create Quality Pet Time, Even if You’re Crazy Busy

By Dr. Karen Becker

 

In case you hadn’t noticed (and how could you not?), you are the center of your dog’s universe. You are the sun, the moon and the stars to your canine companion. Given their lifelong devotion to us, we often wonder how we can ever repay our dogs for their unconditional love — especially when, in terms of time and energy, we’re already stretched to the limit.

Most of us have experienced periods in life when the days, weeks, or even months are just one long, busy blur of work and other commitments. Eventually it occurs to us that we haven’t been paying much attention to our precious furry companion, and yet there he sits — accepting, patient, and ever hopeful.

Unlike a cat who tends to get right up in your face (literally!) when she wants some attention, your dog is more likely to lie quietly at your feet when he can see that you’re busy, or simply sit and wait till you acknowledge him. And let’s face it — there are few things more guilt-inducing than realizing you’ve been ignoring the one friend in your life who would happily follow you off a cliff.

The good news is you don’t need to carve huge chunks of time out of your already overscheduled day to give your dog the undivided attention he needs and deserves. Instead, consider making a few minor adjustments to your usual routine that allow you to include him. With a little imagination, you may be surprised how much quality time you can spend doing things with him that let him know he’s the best dog in the whole wide world.

12 Inventive Ways to Improve Your Dog’s Life in a Hurry

1. Greet the day together — Try waking up 5 or 10 minutes early each morning to cuddle or play with your dog before you get out of bed. Most dogs are wildly happy in the morning and getting a few minutes of cuddle time with you will get your pup’s day off to a delightful start.

2. Be present — This is really just about remaining aware of your dog’s presence and observing his actions, behaviors, and emotions. Your pup is always communicating with you, and he feels loved when he knows you’re tuned into him. When you have two minutes to focus on your pup, really focus.

3. Include her in daily rituals at home — No matter what you’re doing around the house, try to make your dog a part of it. Talk to her in soothing tones as she follows you around or plays with a favorite toy while you get ready for work. Invite her to sit on your lap or lie at your feet while you work, read or watch TV.

4. Take 5-minute play breaks — Look for opportunities to play a quick game of tug while you’re doing chores or getting ready for work. Play hide-and-seek with your dog while you’re doing housework. Roll a ball down the stairs and have him retrieve it. When you bring home a new toy, make it extra-special by spending a few minutes playing with it with your dog.

5. Break out the brush — Many dogs really love to have their coats gently brushed. Be sure to avoid the face and go easy on the tail and the tender skin across the belly.

6. Make like a masseuse — Try spending 30 to 60 seconds gently stroking and massaging alternating areas of your dog’s body, avoiding the paws, tail, and backside. You’ll know he’s digging it when his body relaxes and his eyes close.

7. Do 5-minute training sessions — This is a great way to reinforce or refresh your dog’s obedience or trick training and provide her with mental stimulation as well. It’s also an opportunity for you to give her praise, affection, and a few yummy treats.

8. Take speed walks — Dogs absolutely love walks, so even if you only have 5 or 10 minutes to spare, the more often you can take your dog out for a walk, the better. Of course, when you have more time, it’s important to take longer walks to allow him to sniff, pick up his pee-mail, and do some exploring.

9. Take him along — Whenever possible bring your dog with you — to work, when you’re running errands, on road trips, and in any situation where he’ll be safe and welcome. This will not only strengthen the bond you share, it’s also an excellent way to maintain your dog’s socialization skills.

10. Minimize her time alone — Even the easiest going, non-destructive dog will feel isolated if she’s left alone for long stretches several days a week (not to mention she needs the opportunity to relieve herself). If you can’t get home to walk and play with her for a few minutes during the day, I recommend enlisting a friend or neighbor to do it. Another option is to hire a dog walker or consider a few days a week at doggy daycare.

11. Exercise together — If you can’t make the time every day to get your own workout in, much less exercise your dog, consider becoming workout partners. Dogs today don’t get nearly the exercise they need, and like us, they require an incentive to be physically active.

The best way to make sure your dog gets moving is to provide her with the companionship and motivation she needs to stay active. Healthy dogs should be getting an absolute minimum of 20 minutes of sustained heart-thumping exercise three times a week. Thirty minutes or an hour is better than 20, and six or seven days a week is better than three.

12. Beat back boredom — Most dogs have a strong “work mentality,” but in today’s world, we don’t give them fun and engaging “jobs” to do. Boredom is especially a problem for dogs left alone for long periods of time (which as I mentioned earlier, isn’t recommended). Bored dogs can develop annoying or destructive behaviors, for example, gnawing on furniture or chewing holes in carpet.

The very best hedge against boredom is lots and lots of exercise. Dogs who are well-exercised every day typically don’t get bored. Some great activities to consider doing with your dog include hiking, jogging, swimming and fetching a ball or playing Frisbee. Obedience training, nose work and interactive toys are excellent ways to keep your dog challenged and mentally sharp.

Improving your dog’s quality of life today can pay both immediate and future dividends in terms of his health and well-being. As an added bonus, you can shed those feelings of guilt that you aren’t doing enough for your furry best friend.

 

Cat losing weight? This may be why….

Cat losing weight?  This may be why….

Reviewed and updated for accuracy on November 8, 2019 by Dr. Elizabeth Bales, DVM as seen in PetMD

 

It’s not always easy to detect weight loss in your cat. The fluff of fur covering most cats can serve as camouflage for weight loss until there is a big change.

 

Unintentional weight loss in cats can be a cause for concern. If you weren’t trying to help your cat lose weight, and especially if your cat is a senior, there might be a health issue to blame.

 

The causes of unintentional weight loss in cats range from simple lifestyle changes to serious illness. Any noticeable weight loss in your cat warrants a visit to your veterinarian to rule out serious health conditions. They will be able to run the necessary tests to determine what might be at the root of the problem.

 

Here are some possible reasons why your cat is losing weight and what you should do about it.

 

Reasons Your Cat Might Be Losing Weight

 

Below is a list of a few common causes of weight loss in cats.

 

Not Getting Enough Food

 

Sometimes, your cat is eating less than you think.

 

Do you have another cat or dog in the house? Additional pets in your home could be eating your cat’s food or obstructing your cat’s access to their food bowl.

 

Or did you recently change brands of food? The calorie content in a cup of food can vary greatly from one brand to another.

 

Is the food dish up high on a counter? Your cat could be experiencing pain from arthritis that is making it difficult to jump up to where the food dish is.

 

Your veterinarian can help you determine if there are obstacles in your home that are preventing your cat from getting enough food.

 

Intestinal Parasites

 

Intestinal parasites are very common in cats and can lead to weight loss if left untreated.

 

Pregnant mothers can give their kittens parasites, and they can also pass parasites through their milk when they are nursing. Cats can also get parasites from hunting and eating prey, or even by walking through contaminated grass and dirt and then grooming.

 

Your vet can examine your cat’s feces to determine if he is carrying parasites that might be causing weight loss.

 

If parasites are the cause, a simple dewormer, directed at the appropriate parasite, can put your cat back on the road to a healthy weight.

 

Feline Diabetes

 

Diabetes is very common in cats and will require immediate veterinary care and ongoing treatment.

 

In addition to unexplained weight loss, diabetic cats typically drink an abnormally large amount of water and urinate large volumes as well.

 

Overtime, without treatment, diabetes is a fatal condition.

 

If your vet suspects diabetes, they will likely take blood and urine samples to confirm the diagnosis. Successful treatment involves diet changes and often insulin.

 

Feline Hyperthyroidism

 

Cats over 8 years old are at risk for hyperthyroidism.

 

The thyroid is a butterfly-shaped organ that is located in the throat. It produces hormones that perform many functions, including regulating the body’s metabolism.

 

When a cat becomes hyperthyroid, their metabolism goes into overdrive—they lose weight, are ravenously hungry all of the time, have a very high heart rate, and often meow at night and have trouble sleeping. They may also drink a lot of water and urinate large amounts.

 

Your vet will do bloodwork to see if this is the cause of the weight loss.

 

Treatment of hyperthyroidism involves controlling the thyroid gland, either with medicine, special food or inpatient radioactive iodine treatment. Your vet will guide you in choosing the best treatment.

 

Feline Viral Disease

 

FIP, FeLV and FIV are viral diseases in cats. These viruses have different causes and possible therapies, but weight loss is a common symptom of all three.

 

If your vet suspects that a virus is the cause of your cat’s weight loss, they may perform blood tests and possibly more tests to determine if one of these viruses is the cause.

 

If a diagnosis is made, management and treatment will be based on the symptoms your cat is showing.

 

Feline Kidney Disease

 

Feline kidney disease can also lead to weight loss in your cat.

 

To determine if kidney disease is the cause of your cat’s weight loss, your vet will do bloodwork and a urinalysis.

 

Treatment may include prescription food, medicine and even sterile fluids that your vet can teach you to administer at home on a regular basis.

 

Feline Cancer

 

Many different forms of cancer can cause weight loss.

 

The diagnosis and treatment plan will vary depending on the kind and stage of cancer suspected. Your vet might do some or all of the following to confirm a diagnosis:

 

·         Bloodwork

·         Urinalysis

·         X-rays

·         Ultrasound and/or biopsies

 

Always Discuss Cat Weight Loss With Your Veterinarian

 

Unintentional weight loss is a nonspecific sign that can have many causes. Anything short of a veterinary visit is just a guess.

 

If you notice that your cat is losing weight, you need to call the vet. Make the appointment now.

 

Your vet should have a documented weight from the last visit and can confirm the weight loss.

 

They will take a thorough history and do a complete physical exam. Based on those findings, your vet might recommend a fecal exam to check for intestinal parasites, and bloodwork to check for clues to get to the bottom of what is causing the weight loss.

 

Happy Cat??

By Dr. Karen Becker and comments by Diane Weinmann

 

How to Create a Happy Cat

In addition to feeding a nutritionally optimal, species-appropriate diet, keeping kitty at a lean-and-healthy weight, and providing exercise incentives, there are several components to her indoor environment that you’ll need to consider from her uniquely feline perspective. These include:

  1. Litterbox location — In the wild, cats not only hunt prey, they are prey for other animals. Certain activities make them vulnerable to predators, including eliminating. This vulnerability is what causes anxiety in your kitty when her litterbox is in a noisy or high traffic area.

Your cat’s “bathroom” should be located in a safe, secure location away from any area that is noisy enough to startle her or make her feel trapped and unable to escape.

  1. The opportunity to “hunt” for meals and snacks — Your cat, while domesticated, has maintained much of his natural drive to engage in the same behaviors as his counterparts in the wild, including hunting for food, which also happens to be excellent exercise. A great way to do that with an indoor cat is to have him “hunt” for his meals and treats.

Separate his daily portion of food into three to five small meals fed throughout the day in a variety of puzzle toys or indoor hunting feeder mice (available for raw and canned food, too!). You can also hide his food bowls or food puzzle toys in various spots around the house.

  1. Places for climbing, scratching, resting, and hiding — Cats are natural climbers and scratchers, and those urges don’t disappear when they move indoors. Your cat also needs her own resting place and a hiding place where she feels untouchable.

Cats prefer to interact with other creatures (including humans) on their own terms, and according to their schedule. Remember: well-balanced indoor kitties are given the opportunity to feel in control of their environment. Jackson Galaxy has written several books on creating feline environmental enrichment around the home that I highly recommend.

  1. Consistency in interactions with humans — Your cat feels most comfortable when his daily routine is predictable, so performing little rituals when you leave the house and return can help him feel more comfortable with your comings and goings. A ritual can be as simple as giving him a treat when you leave and a nice scratch behind the ears as soon as you get home.

Playtime should also be consistent. Learn what types of cat toys he responds to and engage him in play, on his timetable. Of course, while you can encourage him to play, it’s pointless to force the issue. Oh, and when he’s had enough, he’s had enough!

  1. Sensory stimulation — Visual stimulation: Some cats can gaze out the window for hours. Others are captivated by fish in an aquarium. Some even enjoy kitty videos.

Auditory stimulation: When you’re away from home, provide background noise for kitty that is similar to the ambient sounds she hears when you’re at home, for example, music or a TV at low volume. Olfactory stimulation: You can stimulate your cat’s keen sense of smell with cat-safe herbs or synthetic feline pheromones (e.g., Feliway).

All in all, paying attention to your kitty, interacting and talking with them will go a long way to ensure their happiness. Provide stimulation—you get bored right?  Well, they will to!   If they seem upset or sad consider what may have changed in their life or environment to have caused their issue.  When all else fails, contact Diane who is an animal communicator at dianefortheloveofanimals@yahoo.com.

 

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.