Chronic kidney disease (CKD) is one of the most common diseases affecting older cats, with 20-50% over the age of 15 years being affected. One of the main functions of the kidneys is to clear waste products from the blood, and when damage occurs they are less able to do this so the toxins start to build up. In chronic kidney disease, this damage has occurred over a longer period of time and unfortunately the damage cannot be reversed. Even so, for most cats, managing the disease and its resulting complications can significantly slow down progression of the disease and increase both quality and length of life. Signs of CKD can be quite vague at first, but they include weight loss, poor appetite, increased thirst, increased urination, and later on, reduced activity and sometimes vomiting. Diagnosis usually requires a blood sample, which shows an increase in urea and creatinine (waste products that are normally cleared by the kidneys) as well as a urine sample, which shows abnormally low urine concentration (watery urine). If the results of these initial blood and urine tests are not clear cut an additional blood test to measure SDMA may be useful. Once we know that there is kidney disease going on an ultrasound scan or x-ray of the kidneys may sometimes be recommended to try to determine an underlying cause, but this is not usually necessary in older cats with chronic kidney disease. The blood tests may also reveal complications resulting from CKD such as anaemia, low potassium levels or high phosphate levels, which can all be treated effectively if they are present. Cats with CKD can also develop high blood pressure (hypertension), so we also recommend checking their blood pressure. See related post below. Management of CKD depends on the severity of disease, but may include dietary changes, and treatment to manage related complications such potassium supplementation, phosphate binders, management of hypertension, and treatment of anaemia, nausea and poor appetite. In more advanced cases fluid therapy can also be given at home to provide additional support and help to keep cats feeling well for longer. Periodic monitoring, usually at between 3 to 6 month intervals, is important to assess disease progression and adjust treatment to maintain the best possible balance. Although CKD is usually progressive over time, supportive treatment can result in many cats having a good quality of life for several years, especially if it is identified early on. Regular health checks and wellness screening of older cats is particularly helpful in this regard, so if your cat is getting on a bit, ask our vets or nurses for more advice. #hypertension

From a human perspective, a cat depositing faeces and/or urine outside the litter box is completely unacceptable and undesirable. From a cat’s point of view, our feline friend is sending out warning signals, saying “HELP, something is wrong!”. It is important to get an early understanding as to why our cat companion is showing this behaviour. At the Oxford Cat Clinic we can help you to help your kitty feel happy again. Four important differential diagnoses are: Feline Idiopathic cystitis (FIC); pain associated with urination which can lead to a negative association with the litter box; Medical reasons other than FIC e.g. chronic pain that may make the litter box tricky to negotiate, or a disease that causes excessive urination such as diabetes or hyperthyroidism, or a loss of learning associated with age, also known as cognitive dysfunction. Marking – most commonly urine spraying, but marking can also include urine pooling or faecel marking Behavioural reasons for the depositing of urine and/or faeces in inappropriate places – related to primary environmental and social factors. The first two causes we can rule out by an in depth clinical exam and further tests including urine analysis, blood tests and if necessary diagnostic imaging. Do not worry about “how to get a urine sample?” as at the Oxford Cat Clinic we can obtain a sample by cystocentesis. Marking and elimination are not always as easy to distinguish from one another. Both are normal behaviours for cats - but marking and inappropriate elimination usually indicate some form of stress/unhappiness. Thorough history taking, making a time scale and a house plan, helps us identify the stressors in your feline’s life and address them appropriately. Risk factors are plenty; ranging from litter box features, location, litter material and hygiene to multi-cat household, interspecific social interaction (cat/dog/human), reduced access to desirable elimination location or visual intrusion from other cats through windows, patio doors,…We help you explore all these possibilities. Treatment of elimination-related house-soiling problems will involve dealing with potential disease, optimising the litter facilities and addressing your feline’s emotional motivations for undesirable behaviours with reference to the Five Pillars of Healthy Feline Environment. Optimising litter facilities includes providing sufficient number of litter boxes (number of cats +1), distributed in appropriate locations and making sure to position the litter box in a separate, visually protected, easy accessible and safe site, positioning the box away from food and water. Boxes should be an adequate size (ideally 1.5x the length of the cat from nose to base of tail). Providing a choice of hooded and open trays and using a sand-like clumping non-scented litter with adequate depth to rake over the deposit may help. Cleaning at least twice daily and emptying entire contents once a week is recommended, avoiding polythene litter liners or any scented additives. The Five Pillars of Healthy Feline Environment are: Providing a safe place; Providing multiple and separated key environmental resources: food, water, toileting areas, scratching areas, play areas and resting or sleeping areas; Providing opportunity for play and predatory behaviour; Providing positive, consistent and predictable human-cat social interaction; Providing an environment that respects the importance of the cat’s sense of smell. For more info on these Pillars, visit https://journals.sagepub.com/doi/pdf/10.1177/1098612X13477537. For once, human, think outside the box! References: Heath S. Common Feline Problem Behaviours - Unacceptable indoor elimination. J Feline Med Surg, 2019, 21: 199-208. International Cat Care: icatcare.org/advice/problem-behaviour/soiling-indoors

Hyperthyroidism is a common disease of middle age or older cats. It occurs when the levels of thyroid hormone, produced by the thyroid glands in the neck, starts to rise. Thyroid hormones are involved in regulation of the body’s metabolism. Classic signs of hyperthyroidism include increased appetite linked to unexpected weight loss and increased activity levels or restlessness. There can also be an increase in thirst. Other signs can include an unkempt and greasy coat. Occasionally vomiting and diarrhoea are seen. On examination, affected cats often have increased heart rates and an enlarged thyroid gland, which will raise the vet’s suspicion. A blood sample to measure thyroid hormone levels is required to confirm the diagnosis as these signs can also been seen with other diseases. It is also important to check for other diseases which can be present at the same time such as kidney disease, liver disease and diabetes. Treatment is always recommended, as uncontrolled hyperthyroidism can lead to other complications. The most damaging are heart disease (and potentially heart failure) and hypertension (high blood pressure), which, if left untreated, can cause damage to the eyes (including sudden blindness), heart, kidneys and brain. Medication is recommended for initial stabilisation. Once the thyroid levels are stable there are four main options for longer-term treatment, which can be curative. The initial medication comes in the form of tablets, liquid or a gel. Long term treatment options include surgery to remove the affected gland(s), radioactive iodine treatment or in some cases a special diet. Frequently the medical treatment is so simple and successful the owners opt to continue this long-term. Monitoring the response to treatment is important, especially during the initial stabilisation period but also for long term medical management. This ensures is to ensure that the thyroid hormone levels are correct, to monitor kidney function (as sometimes controlling hyperthyroidism can unmask pre-existing kidney problems) and to check for any side effects of treatment. Most cats that are diagnosed with hyperthyroidism can be treated very successfully and go on to lead normal lives. In the majority of cases treatment can be very rewarding as a cat that was distressed and losing condition becomes more contented and clearly more healthy.

Now that we can put thoughts of snow and ice behind us, it is time to look ahead to the warmer months. For many of us this means a spring clean and gardening. Our feline friends appreciate the rays of sunshine and will be exploring again and trying to “help” with our activities, however with this do come a few hazards and we must make sure we keep our cats safe in the home and garden. With Easter fast approaching, the Easter Lily springs to mind. All lilies are poisonous to cats, and all parts of the plant are toxic. Even a small exposure to pollen can potentially lead to severe kidney damage. Certain garden products, cleaning and DIY-products can be hazardous to our felines. Anti-coagulant rodenticides- a type of rat bait- can cause bruising and bleeding after ingestion. Methaldehyde slug and snail killers are highly toxic and cause seizuring if eaten. Detergents containing benzalkonium chloride can cause drooling, fever and tongue and mouth ulceration if your cat licks a treated surface. Tiny amounts of anti-freeze, either spilled or used in garden water features, can cause acute kidney injury. Decorating materials such as white spirit, creosote and varnish can be poisonous if groomed from the coat or can cause local irritation to the skin. As the weather gets warmer, some unwanted guests can also visit your pets. Permethrin is a chemical which can be found in flea spot-on products for dogs, in flea powders and collars for cats and lice powder to treat horse rugs with. However Permethrin is toxic to cats and, despite high profile campaigns, permethrin poisonings do still occur. Contact with the product (accidentally applied or close contact) can lead to tremors or convulsions. Sometimes, accidents will happen but we can do our best to try and prevent them by: Storing garden, cleaning and DIY products out of reach of furry paws. Mopping up any spills quickly and never decanting liquids into different containers. Not leaving diluted gardening products in unattended watering cans or buckets. Always dispose safely of any left- over preparations. Always check flea products are safe for cats. If you do fear your feline friend came in contact with a poison, please contact our team at the Oxford Cat Clinic with the ingredient and strength of the product, time of exposure and symptoms the cat is showing. For more info, visit: - https://icatcare.org/advice/cats-and-poisons

Antibiotic use is a topic which is gaining more attention in the media, due to antibiotic resistant bugs becoming more widespread. People are aware of their impact in human health, but what about the impact on our furry friends? And can overuse of antibiotics in companion animals affect human health? When bacteria become resistant to an antibiotic this is often known as antimicrobial resistance or AMR. AMR is becoming a bigger problem because of the overuse of antibiotics for conditions which do not require them, like viral infections, and antibiotics not being given correctly- either the full course not being completed of the correct dose not being given each time. This means it is important to follow instructions carefully and always finish a course of antibiotics. Problems can arise if your pet picks up a bacteria which is resistant to one or more antibiotics and this can lead to the infection being more difficult to treat. We often prescribe antibiotics known as ‘broad spectrum’ as these kill or inhibit a wide range of bacteria, however use of these leads to a higher likelihood of resistance occurring. For this reason we try to use as narrow spectrum an antibiotic as possible to affect less of the naturally occurring ‘good’ bacteria in our patients, and only use antibiotics when it is necessary, by sending samples for culture when possible. Human health can be affected as well if our pet’s pick up a resistant bacterial infection. We love our cuddly companions and therefore share a lot of our home with them and interact with them closely. Some bacteria can pass between animals and humans, and if these are antibiotic resistant they can be a problem for us too. We use an approach know as ‘One Health’ to work together with our human colleagues to reduce antibiotic resistance in us and our pets so we can make sure antibiotics are still available to us in the years to come. So please, if your pet is unlucky enough to need antibiotics make sure you follow the instructions carefully and finish the course. We try to only prescribe antibiotics when it is necessary so if your pet isn’t prescribed them then feel grateful that your pet is healthy enough not to require these life saving drugs. #antibiotics #cats #antibioticresistance #infections #bacteria #feline #antimicrobialresistance #AMR

Hypertension is the clinical term for high blood pressure. It is recognised as a relatively common problem in older cats, and is often found in conjunction with other conditions such as kidney disease and hyperthyroidism. In some studies over 60% of cats with kidney disease and over 20% of cats with hyperthyroidism were found to have hypertension. If left untreated, hypertension can lead to damage to certain organs - the kidneys, brain, eyes and heart are the most vulnerable, and are also referred to as target organs or sometimes end organs. Signs of hypertension are normally related to damage to these organs, with the main clinical signs including reduced vision or blindness, a change in behaviour, depression, breathlessness, lethargy and increased drinking and urination. Diagnosis of hypertension is made by measuring the blood pressure using an inflatable cuff and a tiny ultrasound probe which we use to listen to the pulse. The cuff is wrapped round one of the front legs or the tail, depending on what your cat is most comfortable with. The back of the eye may also be examined, as it is common to find changes here in cats with hypertension. These tests are painless and most cats tolerate them well. There is a medical treatment for hypertension, which involves daily medication but is very safe and usually very effective. As hypertension is most commonly seen associated with other diseases, it is important these are also investigated and treated. We recommend at cats over 11 years old have their blood pressure measured regularly to prevent damage from happening. At the Oxford Cat Clinic we recommend that all cats have a 6 monthly health check with one of our veterinary nurses between vaccinations, and blood pressure measurement is offered to older cats at this time. #highbloodpressure #hypertension #cats #senior #feline #wellness