Taking Blood Pressure in Cats

Taking blood pressure is important in cats when hypertension is suspected.  We use the Parks's Doppler unit which is the most accurate doppler for cats.  The Doppler method uses a piezoelectric crystal (within the probe) that emits ultrasound waves to detect an arterial pulse. Once the pulse has been detected an inflatable cuff (sphygmomanometer) is inflated proximal to the probe to occlude the artery (Figure 1). This cuff is gradually deflated and the pressure in the cuff during this period is monitored. The pressure to which the cuff is deflated when the pulse is first detected again represents systolic blood pressure.

Calcitriol for Use in Cats with Kidney Issues

Calcitriol (Rocaltrol)

Background
Calcitriol is mostly used in the treatment of chronic kidney failure although it can also be used in hypocalcemia (low blood calcium). The relationship between calcitriol (active Vitamin D) and parathyroid hormone is somewhat complicated but it is not possible to understand the function of this medication without some understanding of the system.
Calcitriol and 1,25 dihydroxycholecalciferol are both scientific names for active vitamin D. The biochemistry of vitamin D is very different from that of other vitamins because vitamin D is actually a hormone. To understand how calcitriol is helpful therapeutically, the following offers some background information about vitamin D, its metabolic opposite parathyroid hormone, and the general calcium and phosphorus balance within the body.
A Review of Vitamin D
The story of vitamin D begins when a vitamin D precursor is eaten. The precursor we get from plants is called ergosterol and the precursor we get from eating animal tissues is called 7- dehydrocholesterol. These substances are absorbed into the body when they are digested and transported to the skin for modification by sunlight radiation (hence the popular terminology of vitamin D as the sunshine vitamin). The animal origin substance is converted to what is called vitamin D3 or cholecalciferol, while the plant substance becomes vitamin D2 or ergocalciferol. From here we will follow the animal origin hormone as it is the most metabolically active.
The next stop is the liver for further modification (a hydroxyl group is added to the 25th carbon of the vitamin D3 molecule) thus forming 25-hydroxycholecalciferol, which is too hard to pronounce and is generally referred to as 25-D3 or calcidiol.
From here, calcidiol circulates to the kidney for its final activation. Another hydroxyl group is added in the final activation to form 1,25 dihydroxycholecalciferol, aka calcitriol.
Actions of Vitamin D and Parathyroid Hormone (PTH)
There are four tiny parathyroid glands around the thyroid gland in the throat area. These glands produce a biochemical called parathyroid hormone, often abbreviated as PTH. When blood calcium drops, PTH is secreted heavily.
Parathyroid hormone encourages the activation of calcidiol into calcitriol by the kidney.
Both PTH and calcitriol act to increase calcium levels by mobilizing calcium from the bones and preventing the kidney from excreting calcium.
PTH may encourage calcitriol activation but calcitriol instructs the parathyroid glands to cut PTH secretion. This means that when there is enough calcitriol, PTH secretion shuts off. This prevents the blood calcium level from increasing out of control.
There is a third hormone called calcitonin that is responsible for excess calcium returning to the bones for storage.
When it comes to phosphorus PTH and calcitriol act as opposites.
Calcitriol acts to have the kidney retain phosphorus while PTH instructs the kidney to dump phosphorus.

These hormones work together to maintain the blood calcium level in a specific range. What Happens in Kidney Failure? In early kidney failure, the kidney is not able to activate vitamin D efficiently nor is it able to adequately excrete phosphorus. As a result active vitamin D levels drop (which results in a drop in blood calcium) and blood phosphate levels start to climb. The calcium drop is seen by the parathyroid gland, PTH is released, and hopefully the situation can be normalized. But the kidney may not have enough capacity to activate vitamin D no matter how much PTH is circulating. More and more PTH is desperately secreted to get some vitamin D activated and to get the excess phosphorus dumped. The kidney simply cannot respond. Soon there is so much circulating phosphate that it begins to combine with the blood calcium, and calcium phosphate crystals begin to form in the body’s soft tissues (which, of course, further lowers blood calcium levels). This removal of calcium from the circulation causes the bones to release all available calcium in an attempt to maintain a normal blood calcium level. The bones becomes soft and bendable (this is classically most notable in the jaws, leading to the condition in advanced kidney failure called rubber jaw.) The bone crystals in the soft tissues generate an inflammatory response. None of the tissues involved can function normally. A metabolic disaster has occurred. How this Medication is Used By giving active vitamin D in pill or liquid form, the above disaster can hopefully be averted or reversed. (It is more easily averted than reversed.) It has been established that PTH is an important toxin in kidney failure and we want to reduce its secretion. This is best done with minute (measured in units 1000 times smaller than the usual dosages) quantities of vitamin D. These quantities are enough to shut off PTH secretion but are not high enough to lead to elevated phosphorus levels. If calcitriol is started early in kidney failure, parathyroid levels may be kept low enough that calcium/phosphorus imbalance never becomes an issue. If it is started later in failure, it is helpful but may not be able to provide as good a response. Recently a survey of the owners and veterinarians of nearly 2000 pets in chronic renal failure was taken. The animals all received calcitriol. Approximately 80% of the owners reported that their pets were brighter and more social and had better appetites on calcitriol. It was also felt that these animals had a substantially longer life span than patients not receiving calcitriol. Side Effects If calcitriol elevates serum calcium levels, this can lead to calcium precipitation in the kidneys, making kidney damage worse. Calcitriol cannot be given to patients with elevated serum calcium levels, and monitoring is necessary to make sure serum calcium levels do not rise. Interactions with other Drugs Phosphate binders are common in the treatment of kidney disease. If the binder in use contains calcium, elevated blood calcium levels could become a concern. Cautions and Concerns Calcitriol cannot be used in patients that have an elevated (greater than 6 mg/dl) plasma phosphorus level. Calcitriol might elevate phosphorus further at this stage, which is exactly what we do not want. In such patients, plasma phosphorus must be reduced by diet, fluid administration, or by phosphate binders before calcitriol can be started. It is helpful to monitor PTH levels in patients on calcitriol therapy as some dosage adjustment is sometimes beneficial depending on the PTH level. This kind of monitoring is not crucial to calcitriol use, however. Calcitriol can be given with or without food. Compounding pharmacies are needed to create an oral liquid or capsule in a size beneficial to the individual patient. A commercial vitamin D supplement is not useful (most over the counter formulas include ergocalciferol that the diseased kidney cannot activate, and manufactured doses of the prescription product are too high).

Perfect Litter Boxes

Help for Feline Aggression

• Stop doing the things that trigger the cat.  For example, for cats with petting aggression, don’t pet them.  You can often recognize body signs that cats show when they start to become annoyed.  Their eyes narrow, their ears swivel sideways, they look over their shoulder at the culprit, and their tails twitch.

• Teach the cat to obey a command using the clicker method which is conditionally rewarded with a treat.   

http://www.youtube.com/watch?v=q787R2DNDJI

http://www.youtube.com/watch?v=O6wgbCmaD8o&feature=related

http://www.youtube.com/watch?v=7P_XgJpUTis

The following video is for clicker training your cat to go to a mat but you could use the same technique to train your cat to go to another room (say for example when she is showing signs of aggression).

http://www.youtube.com/watch?v=H2sKw33iX9I

• Exercise!  Spend at least 15 minutes twice a day exercising the cat with a favorite toy, such as a laser light or feather wand.

Cat Food

Domestic cats originated from the Middle East.  They ate small prey such as birds, mice, rabbits, lizards, and bugs.  They did not eat seafood or larger animals such as cattle or venison. Cats are obligate carnivores, meaning that they require a meat diet in order to sustain their nutritional needs. The ability to synthetically produce nutrients such as taurine has allowed the pet food industry to make cat foods that are high in plant matter instead of meat. We believe this has led to a high incidence of health problems in cats including inflammatory bowel disease, pancreatitis, and diabetes.

The following ingredients have been known to cause a considerable amount of intestinal inflammation in cats:

Wheat 

Soy 

Corn 

Beef 

Lamb 

Seafood

We recommend that cats eat poultry or rabbit because it is similar to what they would eat in the wild. Canned food is thought to be more healthy than dry due to the fact that it is almost always lower in carbohydrates and higher in protein and moisture. A diet consisting of canned food only is more healthy for cats, but due to the fact that we all have busy schedules, it may be more convenient to feed some dry and some canned. In addition, some cats are dry food addicts and will not switch to canned food.

Generally cats should eat between 160 to 200 calories daily. As a rule of thumb, canned foods contain about 30 calories per ounce. Dry foods vary from 300 to 600 calories per cup. You can often find the exact caloric content of a particular food on the packaging or online.

Recommended Canned Foods:

Instinct Chicken Formula (pate)
Instinct Duck Formula (pate)
Evo 95% Chicken and Turkey (pate)
Wellness Core Chicken Formula (pate)
Wellness Core Turkey Formula (pate)
There are also Wellness Core cubed and minced meat for cats that don’t like pates.
Before Grain Chicken (pate)
Before Grain Turkey (pate)

Before Grain Quail and Chicken (pate)
Homestyle Duck and Chicken Stew (meat in gravy)

Homestyle Turkey and Liver Stew (meat in gravy)

The dry foods that we recommend contain less than 10% carbs, and more than 45% protein.

Recommended Dry Foods:

Evo Turkey and Chicken Formula 603 cal / cup 

GO Chicken/Turkey/Duck 473 cal / cup

Many people feed raw diets to their cats. We do not recommend feeding only raw, but rather feeding a variety of canned and raw due to the fact that few studies have been done to ensure that raw foods contain the required nutrients for cats. There is also a risk that raw foods contain bacteria such as salmonella and E. Coli so handling it properly when feeding it is important. Instinct by Nature’s Variety does pressure pasteurize their raw food so it may be safer.

Recommended Raw Foods:
Chicken Formula - Instinct Raw Frozen Diet 

Organic Chicken Formula - Instinct Raw Frozen Diet

10 Signs of Illness in Cats

1Inappropriate elimination A cat that urinates inappropri- ately could have any number of conditions associated with the behavior, including lower urinary tract disease, kidney disease, uri- nary tract infection, and diabetes mellitus. It can also be a sign of arthritis, which makes it difficult for cats to get into the litter box.

2Changes in interaction Cats are social animals, so changes in interactions with humans or pets can signal disease, fear, anxiety, or pain.

3Changes in activity

A decrease in activity is often a sign of arthritis or systemic illness, while an increase in activity can be caused by hyperthyroidism.

4Changes in sleeping habits

If your cat is sleeping more than normal (keep in mind that average adult cats may sleep 16 to 18 hours a day—though much of that is “catnapping”), it could be a sign of an underlying disease.

5Changes in food and water consumption Most cats are not finicky eaters. Decreased food intake can be a sign of several disorders, ranging from poor dental health to cancer. Increased food consumption can be caused by diabetes mellitus, hyperthyroidism, or other health problems.

6Unexplained weight loss or gain Sudden weight loss can be a sign of hyperthyroidism, diabe- tes mellitus, or a host of other diseases. Obesity, on the other hand, can cause an increased risk of diabetes mellitus, joint disease, and other problems.

7

Changes in

grooming

Patches of hair loss or a greasy or matted appearance can signal an underlying disease. Cats who

have difficulty grooming often suffer from fear, anxi- ety, obesity, or other illnesses. An increase in groom- ing may signal a skin problem.

8

Signs of stress

Stressed cats may exhibit signs of depression,

hide more, or spend more time awake and scanning their environment. These signs may indicate a medi- cal condition, so it’s important to rule out physical ailments before addressing the stress behaviorally.

9

Changes in vocalization

An increase in vocalization or howling is often

seen with an underlying condition like hyperthyroid- ism or high blood pressure. Many cats also vocalize more if they’re in pain or anxious.

10

Bad breath

Bad breath is an early indicator of an oral problem—studies have shown that 70 percent of cats have gum disease as early as age 3.

Adapted from healthycatsforlife.com and Dr. Susan Little, DABVP (feline), Bytown Cat Hospital in Ottawa, Ontario

Cat Life Stages

Kitten                      Birth to 6 months
Junior                      7 months to 2 years
Prime/Adult            3 to 6 years
Mature                    7 to 10 years
Senior                     11 to 14 years
Geriatric                  15 plus years