A First-Timer’s Guide to Caring for a Cat

A First-Timer’s Guide to Caring for a Cat

By Cindy Aldridge

 

As it was once so succinctly put, “Everybody wants to be a cat, because a cat’s the only cat who knows where it’s at.” Although being a cat may be out of our reach, having one might just be the next best thing. If you’re preparing for your first cat, you’re in for an exciting journey. Cats are curious creatures, and they’ll spark plenty of joy and laughter for years to come. Here are some tips for getting your first cat and making it feel at home.

 

Choosing a Cat

 

Your first step is figuring out what kind of cat you want to adopt. A first-time cat owner might be tempted to pick up a kitten, but that’s probably not the best call. Kittens are cute, but they’re also very high energy and tons of work. Moreover, it’s pretty impossible to tell what a kitten’s adult personality will be like, so a young cat is more of a gamble.

 

An adult cat, however, is more mature and settled. When you meet them, you can get a good sense of how cuddly or distant they’ll be, what kind of play they’ll like, and generally what you can expect from them. This will help you find a cat that suits your lifestyle. Cat personalities run the gamut from high-energy hunters to lazy lumps, from lap cats to the look-don’t-touch variety. Spend some time with different cats in the shelter to get a sense for who you click with best.

 

Gearing Up

 

You’ll need some supplies to help your cat feel at home. In addition to the basics — food, bowls, litter box, etc. — you’ll want to get some extras for your new pal. Cats love to go into small, cozy spaces, especially when they’re in an unfamiliar environment. A cat bed, from fancy self-warming models to the old-fashioned types, will give them a safe space to chill out while they adjust, and to nap once they’ve settled in.

 

Another great gift you can give your cat is a cat tree. These are tall structures with lots of levels of seating, usually made of a nice, scratch-safe material. Think of these as kitty jungle gyms. They’ll give your cat the chance to climb, jump, scratch, and lounge.

 

Finally, get plenty of different toys to ensure you’re satisfying your cat’s hunting instincts. Even the laziest cat will need playtime. Not only does this keep them physically healthy, it also helps reduce feline anxiety and aggression. Without playtime to work out energy and instincts, cats can be prone to biting, poor litter box etiquette, and other destructive behaviors.

 

Your New Roommate

 

It’s important to have the right expectations when you bring your new pet home. Cats have instincts of both predator and prey creatures, and they tend to be skittish in new environments. Many people barely see their cats for the first few days or even weeks after they’ve brought them home. This is okay! Your kitty needs time to adjust and feel safe around you.

 

The best thing you can do during this period is to give your cat distance and let them come to you. It may take some time, but being patient will pay off. By following your cat’s cues and allowing them to define the relationship, you send off signals that say “I’m safe!” Earning your cat’s trust will allow a positive relationship to blossom. Before you know it, you’ll be getting plenty of head boops and slow blinks — sure signs that your cat is in love.

 

Cats are great pets. When you get your first one, it may take you a little while to understand their style of communication and learn their personality. Once you do, however, you’ll see why so many people are obsessed with these wonderful creatures.

 

5 Questions to Ask Before Saying ‘Yes’ to Expensive Surgery

5 Questions to Ask Before Saying ‘Yes’ to Expensive Surgery

By Dr. Karen Becker and comments by Diane Weinmann

Some of the most difficult decisions we make as pet parents involve the treatment and ongoing care of an animal companion who is seriously ill or incapacitated.

Veterinary medicine is evolving in terms of new treatments, but just because a treatment is available doesn’t mean it’s appropriate in every situation. In fact, sometimes, refusing treatment is actually the best decision a person can make for their pet’s quality of life.

Asking the Right Questions

Receiving the news that a dog or cat is seriously ill or injured is extremely upsetting for most pet parents, but it’s important to keep your wits about you so that you can formulate the right questions to ask your veterinarian.

At a minimum, you need to know what’s wrong with your pet, the extent of the illness or injury, what treatment options are available and associated costs, and the best-case and worst-case scenarios for each type of treatment.

Armed with this information, I recommend you take a day or two to think things over and write down any additional questions or concerns that arise. This is also a good time to consider a second opinion, perhaps with a specialist such as a veterinary cardiologist, oncologist, or surgeon, depending on what’s wrong with your pet. Questions to ask yourself as you contemplate your pet’s treatment options:

  • What is in the overall best interests of my pet? This is a gut check to ensure it’s your pet’s interests and not your own that remain your primary focus.
  • How difficult will treatment be for my pet? If, for example, your cat is stressed out by car rides and veterinary visits, a course of treatment that requires lots of both will add to her discomfort and anxiety.
  • Will the recommended tests and treatments change my pet’s outcome? Unfortunately, sometimes “doing everything possible” in terms of diagnostic tests and treatments delivers no benefit whatsoever beyond helping pet parents feel they “did everything possible.”
  • Will the treatment offer my pet an improved quality of life? This is arguably the most important consideration.
  • What can I realistically afford in terms of financial and time commitments?

Planning Ahead

Preparation is priceless. I recommend establishing treatment boundaries before you find yourself in a situation in which your emotions are running high and you’re more apt to make decisions you may later regret. Some of the situations below are extremely difficult to contemplate, but whenever possible, it’s best to do so with a clear head. Things to consider:

  1. How will I pay for my pet’s treatment? You can find information on pet health insurance, other options to pay for pet care, and preventive care tips in my article One of the Most Neglected Aspects of Pet Ownership.
  2. How far will I go with treatment for my pet? Generally speaking, it makes little sense to put an elderly pet through a course of treatment (e.g., an amputation, back surgery, or removal of a major organ) that probably won’t improve and may even detract from his quality of life.
  3. How many invasive procedures will I allow my pet to undergo? Set an “invasiveness tolerance level” for your animal based on your own feelings and beliefs — your wise inner voice. For example, an ultrasound is a three-dimensional image taken with an external device that is entirely non-invasive but could be stressful for your pet.

Exploratory surgery, on the other hand, is the definition of invasive. Your pet will be put under general anesthesia, opened up, and her internal organs explored. If you’re unwilling to put your pet under the knife but you’re okay with an ultrasound, write it down so you know in advance how you feel about invasive procedures.

  1. How far will I let my pet be pushed? This involves assessing your pet’s individual stress tolerance level. If you must pack your elderly housecat off to an emergency clinic with dozens of barking dogs, bright lights, odd smells and strange people, it can be overwhelmingly stressful for her.

In such a case, you may decide not to put her through certain procedures — even if they’re warranted and you’d prefer they be done — because you know she’ll very likely have an emotional meltdown simply from the stress of the situation. Identify your pet’s stress threshold and make a decision ahead of time not to go beyond it.

  1. How do I feel about resuscitation and other end-stage issues? If your beloved pet slips into a coma at an emergency animal hospital, do you want the staff to perform CPR, or are you prepared let him go? If you want your pet saved at all costs, will you be able to manage a critically ill animal, perhaps on life support?
  2. How do I feel about euthanasia? Sort out your thoughts and feelings about euthanasia. Think about whether you agree in principle with it. If you must euthanize your pet, would you want it done at home? Which family members would be involved? How about your children, if you have any, and other pets?
  3. How do you want your pet’s remains handled upon death? Do you want to take her home for burial? Would you like her cremated and the ashes returned to you? Or would you prefer to leave the remains at the clinic for disposal? Try to give the situation some thought before the time arrives. Only you know what’s best for your pet, and for you and your family.

Taking Care of Yourself While You Care for Your Pet

Sharing your life with a pet brings immeasurable amounts of joy and unconditional love, but when your pet becomes ill, caring for him can take a toll on your mental health. Researchers assessed what they called “caregiver burden” in 238 owners of a dog or a cat.

It’s well known that caregivers of human patients facing a chronic or terminal illness experience heightened levels of stress, depression and anxiety, so the researchers set out to determine if the same held true for pet caregivers.

As you might suspect, the answer is yes. Compared to owners of healthy animals, the results showed greater burden, stress and symptoms of depression and anxiety, as well as poorer quality of life, in owners of pets with chronic or terminal disease.1 In turn, the feeling of higher burden was linked to reduced psychosocial functioning.

It’s important to remember that you can’t care for your pet unless you care for yourself first. Practice positive self-care, from eating right to getting enough sleep, and reach out for support when you need it.

For many, the emotional toll is the hardest part of caring for a sick pet, which is why expressing your thoughts and feelings is crucial.

You needn’t keep your emotions bottled up; what you’re feeling — perhaps failure, frustration, inadequacy or guilt — is valid and by sharing your thoughts — in a journal, with a friend or in a support group — you can ultimately move past them and let them go. The International Association for Animal Hospice and Palliative Care (IAAHPC) states:2

“We encourage you to reach out to like-minded individuals in your community and online who have experienced similar situations, and ‘get it.’ Look to your local animal shelters, veterinary association, and pet funeral homes for pet loss support groups. Human hospice programs in your community offer grief and bereavement services to the public (interview them for their views on pet hospice first).”

In addition, if you’re feeling overwhelmed with decisions and information regarding your pet’s illness, ask for explanations from your veterinarian, and realize that you don’t have to shoulder the burden alone. If you need a moment to regroup, ask a close friend or family member to care for your pet so you can focus on stress relief.

“[T]he ability to think clearly will directly affect how effective you can be in your care for your animal companion,” IAAHPC notes. “Respite, or some time away from caregiving, can be important to your continued well-being.”

Despite the stress and, oftentimes, uncertainty, there can be great solace in being there for your pet when he needs you most. Sometimes, if you’re feeling anxious or overwhelmed the best thing you can do is to simply sit and be with your pet in the present moment.

As an alternative, consulting with an animal communicator, like Diane Weinmann, to obtain the wishes of your pet, along with signs that they will display if they are ready to transition into spirit and if they want assistance with that journey can also take the uncertainty of the situation away.

Take some deep breaths, practice mindfulness or meditation, and your calmness will likely be felt by your pet as well.

 

DO CATS LOSE THEIR TEETH??

DO CATS LOSE THEIR TEETH??

By: Laci Schaible, DVM, CVJ as seen in PetMD

 

Should you worry if your cat loses a tooth? Is it normal?

 

It depends on whether you’re talking about a kitten or an adult cat. Here’s a closer look at kitten and cat teeth so you’ll know when tooth loss is normal and when you need to visit the vet.

 

Do Kittens Lose Their Baby Teeth?

 

Like humans and all other domestic animals, cats do go through two sets of teeth throughout their lives—kitten teeth and adult cat teeth.

 

Kitten Teeth

 

At only a few weeks of age, kittens will begin to get their baby teeth, which are also called “milk teeth” or deciduous teeth.

 

The incisors—the small front teeth—are the first to erupt at 2-4 weeks of age. The premolars—larger teeth towards the back of the mouth—are the last to appear at 5-6 weeks of age, for a total of 26 baby teeth.

 

Kitten Teeth
Type of Tooth # Upper Teeth # Lower Teeth Age of Eruption

(weeks)

Function
Incisors 6 6 3-4 Grasping
Canines 2 2 3-4 Tearing
Premolars 6 4 5-6 Grinding
Molars 0 0 —- Grinding

 

Adult Cat Teeth

 

Around 4-7 months of age, permanent (adult) teeth will start replacing the baby teeth.

 

You may never even see the teeth as your kitten loses them, as they are often lost during mealtime or through play.

 

Long before their first birthday, your growing kitten should have 30 permanent teeth. Barring injury or oral disease, these should keep your kitty chewing into old age.

 

Adult Cat Teeth
Type of Tooth # Upper Teeth # Lower Teeth Age of Eruption

(months)

Function
Incisors 6 6 3.5-4.5 Grasping
Canines 2 2 5 Tearing
Premolars 6 4 4.5-6 Grinding
Molars 2 2 4-5 Grinding

 

What If Kittens Don’t Lose Their Baby Teeth?

 

The most commonly encountered tooth problem in kittens is the retention of baby teeth.

 

If the baby teeth are not lost when the corresponding permanent teeth are coming in, it can result in abnormal tooth position and bite, tartar and plaque buildup, and even abscesses.

 

But there are typically no complications if retained baby teeth are removed promptly by a veterinarian.

 

Is It Normal for Adult Cats to Lose Teeth?

 

It’s not normal for adult cats to lose any teeth.

 

In adult cats, dental disease can start to escalate, and tooth loss can occur in cats suffering from severe dental issues.

 

Dental Disease and Tooth Loss in Adult Cats

 

While cats do not develop cavities like humans do, this does not make them exempt from dental disease and tooth loss.

 

In fact, dental disease is such a common feline ailment that approximately two-thirds of cats over 3 years of age have some degree of dental disease. Of course, not all tooth loss is caused by dental disease, and not all dental disease results in tooth loss.

 

As with humans, cats accumulate bacterial plaque on the surface of their teeth. If the plaque is not removed quickly, it becomes mineralized to form tartar and calculus.

 

If dental disease is caught at an early stage, a thorough dental scaling and polishing may be able to save most of your cat’s teeth.

 

However, if gingivitis is allowed to persist untreated, then irreversible damage to the bone and ligaments that support the tooth will lead to excessive tooth mobility and eventual tooth loss.

 

If you notice that your adult cat is missing a tooth, or you find a cat tooth around your house, please seek veterinary care, as this is a major sign of painful dental disease.

 

 

By: Laci Schaible, DVM, CVJ

 

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.

 

Thyroid Dysfunction

By Dr. Dodds DVM

Thyroid Dysfunction is the most frequently recognized endocrine disorder of pets and it’s often difficult to make a definitive diagnosis, since many clinical signs mimic those resulting from other causes.

 

Dogs

Hypothyroidism is the most common endocrine disorder of canines. Nearly 90 percent of canine cases result from autoimmune thyroiditis. The heritable nature of this disorder poses significant genetic implications for breeding stock.
Common symptoms to look for in dogs:

  • Scratching  •  Hair loss  •  Seizures  •  Chronic bowel issues • Seizures in adulthood  •  Chewing feet and skin  •  Skin and ear infections  • Behavioral changes: aggression, moodiness, phobias

Cats
Hyperthyroidism in readily induced, especially in geriatric cats, by feeding commercial pet foods, treats and snacks containing excessive amounts of iodine. This finding has led to a major change in the iodine formulations of feline commercial pet foods.

Common symptoms to look for in cats:
Pacing  •  Anxiety  •  Phobias   •  Howling  •  House soiling  • Insatiable hunger  •  Dementia with aging  •  Hunger and weight loss

How to give your indoor cat the best of both worlds

By Dr. Karen Becker and comments by Diane Weinmann

 

Not long ago at a veterinary conference, a Dr. Margie Scherk, a vet from Vancouver, Canada with a feline practice, spoke on the topic of lifestyle risks of indoor versus outdoor cats. One of her points was that while many people believe responsible cat owners keep their pets indoors, “The fact is that cats have not been selectively bred to be indoors 24 hours a day, and many don’t adjust to living in close contact to people — they’re forced to.”1

Lifestyle risks of indoor cats

According to Scherk, who cites a 2005 study published in the journal Applied Animal Behaviour Science,2 the following are risks to cats who live entirely indoors:

Lower urinary tract diseases Boredom
Hyperthyroidism Household hazards (burns, poison exposure, falls)
Obesity Inactivity, decreased fitness
Diabetes Behavior problems (spraying, scratching, obsessive behavior)
Odontoclastic resorptive lesions Dermatologic problems (atopic dermatitis, acral lick dermatitis)

Lifestyle risks of indoor-outdoor and outdoor-only cats

Thanks to KittyCams, researchers have been able to learn plenty about the kinds of risky business free-roaming cats get up to when they’re wandering around outdoors, including:3

Trauma (usually involving being hit by a vehicle) or human abuse Entering storm drains
Parasites Climbing trees
Crossing roads Climbing on roofs
Having non-aggressive contact with unfamiliar cats (infectious disease risk) Having contact with wild animals (injury and disease risk)
Consuming solids or liquids left by owners, baits Crawling into car engines

Cats are also prey for wildlife such as coyotes, mountain lions, wolves and raptors, and fights among outdoor cats can also lead to serious injury and infections, including bite abscesses. Sadly, cruel humans also pose a grave risk to cats through gunshots, poisonings, burnings and asphyxia.4

Infectious diseases, several of which are zoonotic (can be spread to humans) commonly sicken and kill outdoor cats, including feline retroviruses, mycoplasmosis, toxoplasmosis, bartonellosis (cat scratch fever), tularemia, plague and rabies, along with worms, ectoparasites and fungal infections.

Best of both worlds: Cats should live indoors and also spend safe, supervised time outdoors

Given the risks associated with living entirely indoors, Scherk believes it should be the goal of veterinarians to encourage people to make indoor living more suitable for cats by decreasing stressful stimuli and enriching and improving the environment.

I certainly agree. I tend to think of cats like humans; we live in protected, safe environments indoors, but enjoy going outside, and spending lots of time outside, in safe environments. Living indoors all the time isn’t what most cats would choose, nor is it an entirely natural environment for them, but it’s by far the safest life we can choose for them. Letting them roam free outdoors some or all of the time presents much more risk.

But just because your kitty lives inside doesn’t mean she can’t go on supervised visits outside to bask in the sun, exercise and ground herself on a daily basis. Outdoor adventures are wonderful for cats, as long as they’re safe.

I recommend walking your cat in nice weather using a harness. This gets him out into the fresh air, stimulates his senses and gets his paws in direct contact with the ground. An alternative is a safe, fully enclosed catio that prevents him from getting out and other animals from getting in. Many cats with catios spend the majority of their days outside, but safe.

Diane tried walking her cat once but the kitty was so scared she had to bring him back inside so this outdoor experience doesn’t always work; however, some cats love it especially in enclosed strollers!

How to provide your cat with an optimal life indoors

  • Enrich the indoor environment — The term “environmental enrichment” means to improve or enhance the living situation of captive animals to optimize their health, longevity and quality of life. The more comfortable your cat feels in your home, the lower her stress level. Reducing stress is extremely important in keeping cats physically healthy.

Enriching your kitty’s surroundings means creating minimally stressful living quarters and reducing or eliminating changes in her life that cause anxiety. Jackson Galaxy has written several books on creating feline environmental enrichment around the house that I highly recommend.

The essentials of your cat’s life — food, water and litterbox (which should be kept scrupulously clean), 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. Your cat also needs approved places for climbing and scratching (natural feline behaviors) in her indoor environment, as well as her own resting place and a hiding place where she feels untouchable.

Think about what you can do to appeal to your kitty’s visual, auditory and olfactory senses. For example, some cats can gaze out the window for hours, while others are captivated by fish in an aquarium. Some even enjoy kitty videos.

When you’re away from home, open all your shades and blinds to provide natural light during the day. Provide background noise for kitty similar to the ambient sounds she hears when you’re at home, for example, nature music or a TV at low volume. You can stimulate your cat’s keen sense of smell with cat-safe herbs or synthetic feline pheromones.

  • Make sure he gets daily exercise — Consistent daily exercise, including at least 20 minutes of high-intensity activity will help your cat burn fat and increase muscle tone. Make sure he has things to climb on, like a multilevel cat tree or tower. Think like a cat and choose toys and activities that answer his need for hunting, stalking and pouncing on “prey.” One of Diane’s friends had stairs created going up a wall so the cats could jump from one to another or just sit on them! Ingenious!

Because our cats don’t have the freedom they would in the wild, it’s up to us to give them opportunities to practice those natural instincts. A great way to do that is to have your kitty “hunt” for his food. Try separating his daily portion of freeze-dried raw food into three to five small meals fed throughout the day in a variety of puzzle toys or indoor hunting feeder mice, or load them with a small piece of tasty, dehydrated meat treat.

This will encourage him to “hunt” and eat on a schedule similar to his wild cousins, and as an added bonus, he might just sleep through the night thanks to the puzzle toy you give him at bedtime.

  • Feed a moisture-rich, nutritionally balanced, species-appropriate diet — Offering your cat an optimal diet is the single most important thing you can do to help her have a long, healthy life. That’s why it’s important to understand that some foods are metabolically stressful, for example, all dry (kibble) formulas, processed pet food (canned or dry) containing feed-grade (versus human-grade) ingredients and diets containing grains, potatoes or other starches.

The nutrition that generates the least amount of metabolic stress for most cats, regardless of age, is their ancestral diet: whole, raw (or gently cooked), unprocessed, organic, non-GMO and in its natural form. Animal meat should be the foundation of your kitty’s diet throughout her life. Filtered, pure, fresh water in nontoxic metal or glass (not plastic) bowls is also important.

  • Keep your cat at a healthy weight — Tragically, the majority of cats in the U.S. are overweight or obese. The obesity-related diseases overweight kitties inevitably acquire shorten their lifespans and often destroy their quality of life along the way. If you want your kitty by your side and able to get around comfortably for 20 years, one of the worst things you can do is encourage him to get fat.

The first step in keeping your cat at a healthy weight is to feed an optimal diet as I described above. It’s equally important not to free-feed. It’s also important to calculate kcal (kilocalorie) requirements for your cat’s ideal weight and include treats in his total daily calorie count.

  • Schedule regular veterinary wellness exams — I recommend twice-yearly wellness visits because:

◦Changes in your kitty’s health can happen rapidly, especially on the inside where you can’t see it, like sudden changes in kidney health

◦Sick cats often show no signs of illness, but early detection allows for early intervention

◦Semi-annual visits give you and your veterinarian the opportunity to closely monitor changes in your kitty’s behavior and attitude that require further investigation

At a minimum, younger healthy cats should see the vet once a year. Kitties over the age of 7 and those with chronic health conditions should be seen twice a year or more frequently if necessary. If your cat hates car travel, consider a mobile vet who makes house calls.

I recommend that you find a veterinarian whose practice philosophy you’re comfortable with. This may be a holistic or integrative veterinarian, or a conventional veterinarian who doesn’t aggressively promote vaccines, pest preventives or veterinary drugs at every visit. House call vets can also be a great, lower stress option for indoor kitties.

Generally speaking, if you’re dealing with a conventional vet, you’ll need to advocate for your cat and push back as necessary, politely but firmly. Always remember that you have the final say in what treatments and chemicals are administered to your pet.

 

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

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