Feline Stomatitis, Stomatitis in Cats

Dear Dr Gordon: I have a 3 year old Maine Coon cat that has a constant odor coming from the mouth. When I took him to the vet, she was able to look into the back of the mouth and show me my cat’s throat. I couldn’t believe what I was seeing. The back of my cat’s throat was raw and the gum tissue around the teeth was very red. The doctor convinced me to put my cat under anesthesia and biopsy the back part of the throat. All the teeth were cleaned and the biopsy revealed a disease (which I can’t remember) that the doctor says has no cure. I am worried that my cat will suffer his entire life with this sore mouth. Is there anything else that I can do? PB

Dear P.B.

Although it is possible that your cat may have some type of cancer in the back of the mouth (a disease that has no cure), I am hoping it is something else. You probably would have remembered if the doctor had said that your cat has a form of throat cancer. I suspect that the biopsy may have revealed a syndrome we see in a certain percentage of pure breed and mixed breed cats, called lymphocytic and/or plasmacytic stomatitis. Please call the doctor to get the name of the disease, for that can affect treatment and outcome.

It is essential to use immune support such as  Power Probiotic for your kitty to feel better. Probiotics can help restore the natural flora in the mouth and throughout the digestive tract.

Let’s dissect the words describing this syndrome. Stomatitis is an inflammation or infection in the mouth. Ok, so far so good. Lymphocytic and/or plasmacytic is a descriptive term illustrating the type of inflammatory cells that are migrating to this inflamed area.

What causes this infection/inflammation to occur in certain cats and not others? We are not sure.
Some viral infections are suspected of increasing the cat’s susceptibility to this disease. Your cat should be checked for the Feline Immunodeficiency Virus (FIV or Feline Aids virus) and the Feline Leukemia Virus. I suspect your doctor has already done this. If not, get it done. The virus does not cause the disease but makes cats more vulnerable to the disease. Others speculate that certain cats (ones that are genetically predisposed), are having an exuberant response to antigens or foreign invaders in the mouth. The suspected culprits are the bacteria inhabiting the tooth roots of some of these cats.

The syndrome is first recognized in fairly young cats that have halitosis (very bad breath, trouble swallowing, lack of appetite, and sometimes gagging). Examination of the teeth and back part of the throat reveals areas of extreme inflammation. It looks (and I am sure feels) like the worst sore throat you have ever had your entire life.

How is this dealt with? If the cat is FIV or FeLV positive, steps should be taken to insure your cat stays indoors and does not expose other cats to the disease. Oral antibiotics and frequent dental cleanings will help keep the mouth in good shape. Although controversial, acupuncture, interferon and lactoferrin can be used to improve the condition of the cat’s lesions. Supplements that we have seen help include Not Drops and Power Probiotic  If the cat is negative for these viruses, most veterinarians will use some type of strong immunosuppressive drug (like corticosteroids or others) to calm down the inflammation and analgesics to relieve the pain.

Although it may sound very extreme, sometimes full mouth extraction of the teeth is the only thing that will bring about relief and return the cat to a decent quality of life. I have seen several cases over the years that have completely resolve only by removing all of the teeth. Most veterinarians will only do this as a last resort, when all other therapies have failed after repeated attempts. I personally have been reluctant to recommend this procedure because it is difficult for the pet in the short term, expensive for the owner, and time consuming for the doctor. The long term success rate, however, leads me to believe that this may be the only thing that will save the cat from life-long pain and suffering.

Hepatic Lipidosis "fatty liver" in cats

Dr. Dr Gordon: My cat is very sick. I took him to the vet because he had become very lethargic. After the vet ran some tests, he determined that my cat has “fatty liver” disease. My cat is very overweight to begin with, but I did not know that he could get this disease just by being “fat”. The vet said that treatment can be very difficult. Can you help me understand this disease? RK

Lypozyme

Lypozyme is recommended by veterinarians to help cats with hepatic lipidosis. Lypozyme optimizes fat digestion and metabolism. 

Dear RK: I am very sorry to hear that your cat is not feeling well. From time to time, veterinarians encounter cats that develop fatty liver disease or hepatic lipidosis. This is a disease that is specific to the cat, since its’ dietary requirements and metabolism are much different than the dog’s metabolism. Let me explain.

If a cat, especially an overweight cat, stops eating, it can suffer serious liver problems. Cats are extremely dependent upon having protein in their diets. Unlike many species, cats cannot adequately synthesize their own protein from other building blocks. If a cat is not taking in enough protein, it will start breaking down proteins from its body, including important muscle and liver proteins. At the same time, the body is starving for energy, so it mobilizes fat stores for calories, and carries this fat to the liver for processing. Normally, the liver would metabolize these fats to use them for energy, store them, or secrete them through bile. If the liver is missing some of the proteins needed for fat metabolism, all a liver cell can do is store the fat. The fat builds up inside the cells, a condition called hepatic lipidosis, or "fatty liver,"and the cells swell, pinching off bile ducts. Bile, with all its waste products, cannot empty from the liver into the intestine as it normally does, and the cat becomes jaundiced.These changes in the liver occur within 36 hours of not eating. Since the liver cannot metabolize the fat for energy, the cat suffers further starvation, setting up a vicious cycle of fat mobilization and liver damage. Although this buildup of fat inside liver cells is often associated with diseases that cause decreased appetite, or metabolic disorders such as diabetes, we also see cases that are idiopathic, or have no identifiable underlying cause.

The diagnosis is made by doing blood tests that may first indicate an increase in the liver enzyme values. Usually an ultrasound exam of the abdomen should be the next step, which usually shows the liver that is extremely “shiny” on the ultrasound image. A fine needle aspirate can then be sent to the lab so that the pathologist can definitively diagnose the problem.

Treatment of the condition can be difficult. If there are any underlying diseases that are causing the cat to have stopped eating (infection, inflammation, etc.), these must be addressed to allow the cat to feel better. But the cornerstone of therapy is to get the cat to eat once again. Many times, this is more difficult than it sounds, for the cats in this situation usually do not feel well enough to have any appetite  and they need a lot of calories to offset the metabolic effects of the disease. To counteract this, the veterinarian will usually suggest syringe feeding a very high protein and high carbohydrate diet up to 4 times a day. Sometimes appetite stimulants are used to encourage eating. If the patient is resistant to syringe feedings, a special feeding tube may need to be surgically placed in order to provide the cat with adequate nutrients to reverse the process. Once the cat starts eating on its own, the feeding tube can be removed.

Fortunately, most cases of fatty liver are reversible with intense veterinary care. Although most cats present being very ill and lethargic, the majority are able to recover as long as they begin eating on their own. This may take several days of hospitalization at the veterinary clinic however. This underlies the importance of keeping cats at a healthy weight and realizing that any change in the cat’s normal routine or food, can cause the cat to stop eating, possibly resulting in “fatty liver”.

In addition to getting the cat on a healthy diet, supportive care using liver supplements can help. Products such as Pet Liver Rescue, Special SAMe and digestive enzymes containing lipase such as Lypozyme may be helpful in addition to the care provided by your veterinarian.

Dodger--An Adorable Cute Cairn Terrier Mix Needs a Home

Adorable, sweet Dodger needs your help. Dodger is a 1 year old Schipperke/Cairn Terrier mix. He is a very loving, sweet happy dog who only weighs 12 pounds. His fur is short, chocolate brown and easy to groom. He loves to ride in the car, as shown above and is good with other dogs. Please call Ariel Rescue at 949-499-9380 if you live in Southern California and would like to adopt him. More information can be found on www.petfinder.com under Ariel Rescue.

Adoptions have been slow due to the economy so please spread the word!

Arthritis in Dogs--NSAIDS and Joint Support Supplements

If your dog has been diagnosed with arthritis, is slowing down with age, limping or showing signs of difficulty getting up and down, it is important that you take your pet to the veterinarian for an examination. Quite commonly, your dog may be diagnosed with arthritis. In an effort to promote quality of life and keep the dog comfortable, non-steroidal anti-inflammatories (NSAIDs) will often be prescribed. Examples are Rimadyl, Metacam and Deramaxx to name a few. While these medications are helpful for chronic pain management, they do have side effects especially affecting the liver. This is why your veterinarian will often recommend that if your pet is using NSAIDs that your dog get a blood test every so often to check your dog's liver values. While NSAIDs can be very helpful and even critical for some pets that are in chronic pain, for most pets, there are holistic alternatives that should be tried first and/or in conjunction with their use. Many of our clients are confused about these medications and somehow think that because their dog is no longer limping or in pain, that the joint or limb problem has been cured. This is not at all the case--in fact, it is quite the contrary. The medication is actually reducing inflammation which is giving temporary pain relief.

To really help support your dog's long-term pain, mobility and joints, you need to use vitamins and nutritional supplements that are proven to help. Many minerals such as calcium, nutraceuticals such as glucosamine and herbs such as turmeric and boswelia have been shown to help. It is important to find combination formulas that contain a comprehensive mixture of vitamins, herbs and nutraceuticals.  We have had excellent success using Special SAMe along with the ArthroStride.   It is absolutely essential to use the Special SAMe if your dog has been using NSAIDs as long term use can compromise liver health.  Special SAMe is scientifically proven to help with arthritis and is a vital antioxidant to support the liver.  The ArthroStride includes key nutrients such as Curcumin and Omega 3s along with herbs such as bowelia and glucosamine to improve mobility and joint health. The Omega 3 fish oils found in Amazing Omegas help reduce inflammation and are derived from sardines and anchovies and are at a much more therapeutic level than salmon or other fish oils for pets. Many times using these nutritional formulas can be enough that the dog may only require NSAIDs after heavy exercise.

It is important that you use these formulas, if possible, as your dog starts to age, rather than waiting until the arthritis has set in. But, it is never too late to start with them and they can certainly be beneficial to use in addition to using NSAIDs. Many clients report that they were able to greatly reduce the frequency of using NSAIDs on their dog because of the benefits achieved from using these nutritional supplements.

Finally, acupuncture and chiropractic for dogs are also very important considerations. Ariel was able to run and jump at 14 years of age because of her weekly chiropractic and acupuncture treatments. To find a veterinarian who performs acupuncture in your area, go to www.ahvma.org

Canine Kidney Disease and Inappetance

Inappetance, particularly in the morning for an older dog may be an early sign that something is wrong. While there can be many causes of a dog not eating, this symptom, along with excess water drinking and frequent urination, is often a sign of canine kidney disease. First and foremost, take your pet to the veterinarian for a blood test--don't try to diagnose your dog yourself! Once you find out about your dog's condition and if canine kidney disease is diagnosed, it is important to make some dietary changes quickly. One pattern that we see frequently is where dogs may not feel like eating all day and then at night, eat too much. This perpetuates the cycle where excess phosphorous builds up in the blood during the night and then the pet will not want to eat in the morning. Purozyme, a proteolytic enzyme formula, given to your dog at bedtime can greatly help. In addition, it is important that the dog be put on a a low phosphorous, reduced protein diet. The dog needs some variety along with a reduced protein/phosphorous diet so that over time, the dog will be more inclined to eat in the morning too. You may need to find certain "comfort foods" such as dog biscuits that the dog really likes and offer them in the morning to get the dog started eating in the morning. Dogs can build up a lot of stomach acid too which can make them feel nauseated. This will affect their appetite too. Unfortunately, when pets have canine kidney disease, they can become very picky eaters. What they might have loved yesterday, they refuse to eat today and most of the time, they only want to eat what is not good for them---protein. Frantic pet owners have a tendency to give their dogs what they want and start giving them more and more protein---just exacerbating the symptoms as the phosphorous builds up in their blood stream. Ask Ariel can help you formulate a homemade diet and give you a number of tips to help with this inappetance issue. Canine kidney disease is tough and if detected early, can be managed but you need an expert veterinary nutritionist or holistic veterinarian to help you ensure you are feeding the appropriate diet.

Kitten With Irritable Bowel Disease, Diarrhea and Colitis Finally Gets Better!

"Dear Susan,

Corny, but in all my 61 years, I don’t believe that I’ve ever written a testimonial, so here’s my first go at one. We consulted a month or so ago via phone about my then 5.5 month old kitten, Misha. Misha, a rescue from our local Humane Society, was in serious condition with hemorrhaging from her colon. Her veterinarian and I had exhausted all possibilities.You quickly identified the cause: food allergies and made some dietary recommendations which I followed. Misha’s veterinarian then started her on Sucralfate and Pepcid AC. In addition, I am adding 1/3 capsule of your Probiotic and 1/3 capsule of digestive enzymes to her pumpkin TID. Within 24 hours, Misha’s bleeding stopped. She loves the pumpkin, but adjusting to canned food and to rabbit took some doing and required an appetite stimulant. Although she still craves other foods, she is now gaining weight. I’ve learned that the pumpkin is essential, not only for its soothing properties, but for the fiber it provides in the absence of grains. She poops only every 48 hours. Misha was, when we consulted, a frightened and very sick kitten. So much had been done to her in order to save her life that she was literally undone.

So was I.

In addition to excellent, compassionate and concerned counsel, you also were aware of my stress and addressed this, as well as Misha’s problems. More, you wrote a personal letter of directions and support along with the products I ordered from you. I was impressed by what you did, Susan. And I thank you. Thank you. And again.

My university career was spent counseling/advising students of all ages, as well as teaching anthropology, so I was aware of your therapeutic expertise as we talked. But you did so much more: the over-time you spent while we talked; your willingness to be a resource; your sending samples of other products; and your personal touches, like the hand-written letter. I am, in addition to my professional “history”, a permitted wildlife rehabilitator with almost 40 years of experience under my belt. Appropriate nutrition is an on-going concern for those who work with wild species; yet I had not ever before encountered so compelling a need in one of the many cats I have rescued and loved over the years.

The service you provide is essential. It’s a gift. I would recommend you to anyone, and have.

Thanks, Susan. With a hug, Marg Smith"

March 2009

Crystals and Bacteria in a Cat or Dog's Urine

Dear Dr Gordon: On a recent well pet check at my vet, the urine analysis from the lab revealed that both my cat and dog have crystals in the urine and bacteria. Both my pets are happy and healthy. How significant is this? BK

Dear BK: First of all, crystals and bacteria in the urine MAY BE a significant medical problem, OR may be nothing at all. What do I mean by this?

Many veterinarians utilize veterinary reference laboratories to analyze blood, urine, stool, and other samples. If urine is collected on a pet that is completely asymptomatic for any urinary problems (no straining to urinate, no blood, no unusual urinary behavior) and submitted to a laboratory for analysis, the presence of crystals in that particular urine sample may have formed en route to the lab.

How is this possible? Sometimes crystals can form from the time the urine was collected to the time it was read at the lab due to changes in temperature and changes in the pH of the urine. Crystals that were soluable in solution at the time of collection can actually crystallize out in the solution over time. Is this significant? In a pet that is symptomatic, crystals in the urine are significant. If the pet is completely asymptomatic, then the crystals are probably not a significant issue. However, a fresh urine sample should always be re-examined at the veterinarian's office to make sure crystals are not present immediately after collection. If crystals are present in a fresh sample, these are a real finding and should be addressed. There can be many causes for the formation of crystals. Diet, genetic predisposition, and bacterial infection are some of the culprits. 

The presence of bacteria in the urine can sometimes also be misleading. Veterinarians collect urine in a variety of ways. The best way to collect a urine sample is by a technique called cystocentesis. In this technique, the pet is allowed to build up urine in the urinary bladder and the urine is extracted from the bladder in a sterile fashion. This is usually done by cleansing the area of any surface bacteria on the skin and collecting the urine with a very fine hypodermic needle and syringe. If bacteria are found on this "sterile" collection technique, it is always significant. Sometimes when veterinarians are faced with a particularly uncooperative patient, we will ask that the owners collect a urine sample for us. Even though we hope the sample is collected a aseptically as possible, we realize that collection in this way is less than ideal, and will probably be contaminated to some degree. Almost any sample that is collected at home, by the owner, either by a "mid stream catch" (in the case of a big dog or via the litter box (in the case of cats) will be contaminated. Even though we realize this, it is important to analyze the urine anyway since other findings in the urine may be significant. We can still discern many important facts about the pet's health status from a urine sample collected by the owner. Significant findings could be sugar in the urine, crystals in a fresh sample, the presence of inflammatory cells or cancer cells, protein in the urine, and/or blood in the urine. All of these would be present regardless of how the urine was collected.

Sometimes there actually will be the presence of bacteria, but the lab or veterinarian report that no bacteria were seen. How is this possible? Sometimes the bacteria numbers are very small, or sometimes a very dilute urine will not show any presence of bacteria when examined under the microscope(although they are there). If the doctor suspects that bacteria may be present causing symptioms, and "no bacteria seen" is reported by the lab, he or she may recommend a culture and sensitivity be done on the urine.

To do a culture and senstivity correctly, the sample should be collected straight from the urinary bladder to avoid environmental contamination. Once the urine is collected, it is transferred to a sterile test tube for transport to the lab. Once the urine arrives at the lab, special procedures are employed to enhance the growth of any bacteria that could be present. This involves placing the urine in a test tube containing a special broth to enhance the reproduction of any bacteria found in the urine. After the bacteria are grown in the broth, the bacteria is identified and this solution is "streaked across" a special plate containing another type of growth media. Special small discs, each impregnated with a different antibiotic, are then spread onto this plate. The growth pattern of the bacteria helps determine which antibiotic(s) would be effective in killing the bacteria.

As you can see, there is a big difference in the reporting and interpretation of crystals and bacteria in the urine. DrG

Author:  Dr. David Gordon, Holistic Veterinarian

Arch Beach Veterinary Clinic