Feline Vomiting and Diarrhea – IBD

Inflammatory Bowel Disease (IBD)

Comments from specialists:

• We do not believe it is ‘normal’ for cats to vomit hairballs, but feel it is symptomatic of gastrointestinal disease, especially IBD and its various presentations.
• Cats are built to eat a lot of hair from self-grooming, grooming other cat friends and eating small, furry rodents.
• I might accept vomiting one or two hair balls a year as possibly normal. However, it is more likely the cat is vomiting for some other reason and the owners only see the hair as the problem.
• I don’t rely on laxative-type products in vomiting cats since vomiting is not a “grease” deficiency, just as grease is not a treatment for vomiting people.  I don’t believe that nature created a vomiting species.  Vomiting hair is frequently the result of a motility disorder due to inflammation of the intestines = IBD.

Vomiting and Diarrhea can be acute or chronic. Acute cases have a greater probability of being less serious but some acute causes such as foreign body obstruction and exposure to a toxin can require immediate attention for a good outcome. Chronic disease can be slowly progressing or intermittent or may take weeks or even years before owners are certain that there is a problem.

Owners and veterinarians always hope that vomiting or diarrhea “is nothing”. For example, in cats, vomiting is sometimes dismissed with the comment, “I thought it was just hairballs.” The following list shows how varied and complex the causes can be. Some possible broad categories of causes of vomiting and diarrhea include: viral, bacterial, fungal, protozoal, parasites, obstruction, inflammatory, immune mediated, metabolic, hormonal, systemic disease, cancer, anatomic abnormalities, drug-induced, toxins and an array of adverse reactions to food.

Diagnosing a cause of vomiting or diarrhea requires a series of questions (a good history) and a good physical with abdominal palpation. Treatment can range from supervised observation, to a trial of symptomatic medication, to a diet trial, to tests, which might include, fecal parasites, blood, X-ray, barium, endoscopy with stomach/intestine biopsy and/or ultrasound. Tests are only recommended when warranted because simple approaches have failed.

The purpose of this discussion is to broaden our thoughts beyond “hairball” whenever our cat vomits, even if the vomit is hair.  An examination and a good history with your veterinarian will allow a better understanding of possible causes and a diagnostic and/or treatment plan can be developed.

SPECIAL THANKS to Dr. David Robinson, MD, Deborah Robinson and Noelle

Dr. Robinson and Dr. Earley looking at the high detail monitor.

There is a family that we would like to gratefully acknowledge. This family has been extremely helpful to this practice in many ways through the years. They have especially been of great support and assistance in helping us to bring Minimally Invasive Surgery to Western North Carolina and their wonderful pet, Noelle is the first dog to have a Laparoscopic Spay in this area.

Our Dr. Thompson, Dr. Earley and Dr. Duncan attended advanced training in Laparoscopic Surgery because they recognized the advantages in safety, speed of recovery and reduced pain offered by this technology. The equipment is expensive and complex and some of it is not sold to veterinarians and the assistance of an MD is necessary to purchase the more advanced equipment.

Dr. Earley (left) and Dr. Robinson (right) performing surgery on Noelle.

David Robinson, MD, a human surgeon and his wife Deborah are wonderful animal lovers and they volunteered their expertise and services in “getting us started.” Obviously, it was an honor and a privilege to work with and beside a human surgeon for the first surgery at our facility. Our first Laparoscopic Surgery was performed on Noelle, the Robinson’s personal pet.  Noelle really solidified our confidence that this surgery was ideal for pets when she awoke pain free, happy and was so much more active and playful than pets having traditional surgery.

Noelle

The pictures in this blog show that first surgery with Dr. Robinson, Dr. Earley and Noelle.  Again THANK YOU Robinson family for your help bringing this advancement to our patients.

LAPAROSCOPY - Minimally Invasive Surgery is 65% less painful!*

Laparoscopy now for pets too.

Morgan was spayed laparoscopically and also had a laparoscopic gastropexy.

Laparoscopic surgery is the extremely popular minimally invasive surgery for humans. Now pets can benefit from all of the advantages of this technology. Animal Hospital of North Asheville was the first veterinary hospital in Western North Carolina to equip and train for this capability and continues to be the leader since 2007.

How is Laparoscopy different?

Instead of a large entry incision into the abdomen or chest, one or two very small holes (½ inch) allow a high detail, color, magnifying camera with an integral fiber optic light to enter the abdomen, actually allowing better visualization on a large screen than is possible with the naked eye. Tiny details can be visualized. Then, small, highly specialized instruments are able to enter a small second hole and perform the surgery.

What are the advantages?

Our commitment to this technology benefits our patients. Small incisions allow less depth of anesthesia and result in much reduced postoperative pain, less risk of infection and a faster recovery time. A recent study in the American Veterinary Medical Association Journal showed up to 65% less pain* than with the traditional incision spay. Not only do healthy patients having surgery benefit (such as a spay), but many patients are sick and simply need a small liver biopsy for a diagnosis to be made. These patients need the most gentle, fastest and least traumatic surgery because they are ill.

Specialized instruments make laparoscopic surgery possible.

Dr. Duncan (left) and Dr. Earley (right) performing minimally invasive laparoscopic surgery.

We are the first, and currently the only, veterinary hospital in Western NC to have a human technology, the Harmonic Scalpel. This instrument cuts tissue and seals blood vessels with ultrasonic vibrations rather than a knife or a hot instrument. This technology is much faster than clamping and tying off tissues (less time under anesthesia), reduces risk of bleeding and is less traumatic. The Harmonic Scalpel also benefits patients having open surgery procedures such as spleen removal.

Laparoscopic surgeries that we perform:

• Spay: Removal of the ovaries
• Cryptorchid Castration: Removal of testicles retained in the abdomen.
• Biopsy: Liver, pancreas or abdominal mass
• Abdominal Exploratory: Can visualize abdominal disease when X-ray or Ultrasound is not specific.
• Gastropexy: Prevents life threatening condition in large breed, deep chested dogs termed Gastric Dilatation and Volvulus (GDV) or Bloat
  

  This large screen allows for better visualization during laparoscopic surgery.

Why Don’t More Animal Hospitals Offer Laparoscopic Surgery?

Veterinary schools have not been teaching this technology to students. Learning to use the equipment and the procedures requires a time commitment and specialized continuing education. Also, the education and the equipment are expensive. The Harmonic Scalpel is approximately $20,000 and the operating towers (cameras, electronic recorders, detail monitors and the instruments and ports) can cost $20,000 or more. Veterinary units are beginning to be developed, but all of our equipment (two towers and the harmonic scalpel) is human quality. This equipment requires a form of sterilization that is not commonly found in the veterinary field. We are one of the few in Western NC with that capability. We committed to laparoscopic technology eight years ago as part of embracing our mission statement of looking at every experience as though through the eyes of our patients and thinking what would we do differently if we were the patient. We want to do whatever we can to make your pet comfortable and safe.

What About Cost?
At Animal Hospital of North Asheville, our equipment is used to care for the patients of eight veterinarians and because we frequently have referrals from other veterinary clinics, our equipment does not sit idle as it would if we were a smaller hospital. Using the equipment frequently reduces cost per use and allows for state-of-the-art equipment. For example, our ultrasound is a human GE Logic Ultrasound with color flow doppler; our laparoscopic towers are human Stryker equipment; our Harmonic Scalpel is for humans and made by Ethicon; our X-ray is digital but there are three tiers of digital and we have the most detailed, DR with a Cannon Plate at a cost of $100,000.  Because of our size, we can offer this high quality, at about the same price as other facilities with less expensive equipment. Having this quality of equipment available for your pet allows for a more comfortable recovery, an accurate diagnosis and may actually be life-saving.

FELINE HEART MURMUR: SUSPECT CARDIOMYOPATHY

Mistoffelees has cardiomyopathy and also an arrhythmia (an abnormal heartbeat).

Years ago, a veterinarian might detect a heart murmur during your pet’s annual examination, and you might have heard the comment, “We’ll watch this.”  Not too long ago, veterinary medicine was limited in what could be done diagnostically, and effective heart medications had not been developed.  Now, with new diagnostic capabilities, new knowledge and new medications, many pets with heart disease are living longer and more comfortably than was possible previously.

There are many causes of heart murmurs, and it is impossible to know the cause, the severity or the treatability just by listening with a stethoscope. Causes of heart murmurs in cats include birth defects, valve infection (valvular endocarditis) and the list goes on, but the most common cause is Hypertrophic Cardiomyopathy (hypertrophic = thick, cardio = heart, myo = muscle and pathy = disease).  The heart muscle thickens to the point that there is very little space in the heart for blood to accumulate to be pumped.

A special ultrasound termed an echocardiogram gives us the ability to painlessly see inside the heart while it is beating and evaluate the valves and  heart muscle.  It is the best method available to determine the severity of cat heart disease.  Ultrasound is greatly preferred over x-ray for this disease because x-rays can appear normal until this condition is very advanced.  Having an ultrasound does not require anesthesia, but an occasional pet does need a calming medication.

Dr. Earley performing an echocardiogram on a feline patient.

Echocardiograms are not commonly available in veterinary hospitals.  Animal Hospital of North Asheville is proud to be the first animal hospital in Western North Carolina to have untrasound with color flow and continuous wave doppler for advanced imaging of the heart.  Additionally, Dr. Jim Earley has taken extensive special training and has years of experience in performing echocardiograms for our patients and for referral patients from other veterinary hospitals.

It is important to detect Cardiomyopathy  before the pet develops problems. Many cats can live comfortable, happy lives for many years with medication and monitoring.  Without treatment cats can develop congestive heart failure, or fatal complications such as a “saddle” thrombus, a clot that blocks blood flow to the rear legs and is horribly painful.

Breeds more likley to develop this condition are Ragdolls, Maine Coons, Persians and American and Oriental shorthairs, but the most commonly diagnosed breed is the common domestic shorthair cat.  This condition is more common in young to middle aged cats over a year of age, but can affect any age cat.

ACTUAL CASE: Mistoffelees, (see his picture above), is one of the most striking cats that we have ever seen.  He is a 5 year old Maine Coon who weighs 18 pounds and is not overweight.  His personality is absolutely delightful.

During his Annual Comprehensive Examination, a mild heart murmur was detected.  Dr. Earley recommended an echocardiogram because this was a new murmur and because Maine Coon cats are at higher risk for Hypertrophic Cardiomyopathy.

Unfortunately, the test shows that Mistoffelees does have cardiomyopathy and also has an arrhythmia (an abnormal beat).  Because the arrhythmia is unusual, Dr. Earley recommended a consultation with a cardiologist.  Utilizing our telemedicine capabilities, his data was sent to three cardiologists who have reviewed his case and have made recommendations.  We generally receive a written report from our specialists within 1 hour.  Mistoffelees’ cardiomyopathy has been caught early which gives a better prognosis, and the arrhythmia will be monitored closely to determine if it is stable or unstable.

We all hope that Mistoffelees will continue to feel as wonderful as he does now. Medications will be initiated to treat symptoms should it become necessary.

BROKEN TEETH NEED TREATMENT

Gus came into AHNA with a broken tooth

Acting Quickly = Less Pain & Less Infection

PAINFUL: A broken tooth is painful but as a survival instinct, pets seldom express oral pain.

SUPERFICIAL FRACTURE: When the crown (above the gum line) of a tooth is broken superficially, the dentinal tubules (30,000 tubules per square millimeter) under the enamel are exposed and the pet experiences sensitivity. A sealant can be applied which reduces sensitivity and infection rate.

DEEP FRACTURE: When the crown is fractured deeply enough that the root canal / pulp cavity (nerves and blood vessels) are exposed, you will see a pink spot or actual bleeding.  If you call immediately, we can evaluate the fracture and determine which treatment best meets your needs.

• VITAL PULPOTOMY is an option if the fracture is less than 48 hours old and only the crown is fractured and the patient is less than 2 years old. The fracture is smoothed and contoured and the root canal is sealed. The advantages include that the procedure is non-painful for the pet and the tooth is still alive and continues to grow and strengthen itself. Studies show an 88% success rate when performed within 48 hrs of the fracture and 41% if performed within 2 to 7 days (not advisable). The tooth should be x-rayed 6 months to 1 year later to confirm viability of the tooth. The disadvantage is, it may not work! Repeat x-rays are important.
• EXTRACTION is always a choice with any broken tooth and is the standard treatment if the break goes below the gum line into the root or if it is an unimportant tooth or if there is periodontal disease. Disadvantage is loss of the function of the tooth and advantage is that it is always successful.
• ROOT CANAL THERAPY: Teeth broken more than 48 hours with adequate structure in pets older than 2 years can be retained by performing a root canal procedure. The tooth is dead but continues to function. Success rates are approximately 85% if the tooth is abscessed and 95% if not. This may allow keeping an important tooth and the disadvantage is cost. Tooth should be x-rayed 6 months to a year later to confirm success.

Gus' broken tooth.

Gus' Treated Tooth

Actual Case:  Gus (pictured above) lives with a Lab named Norman. They tried to catch the same ball at the same time and each accidently broke a tooth.  The owner reacted quickly by taking advantage of our evening hours and both pets were examined and then were treated the next morning. Gus’ Vital Pulpotomy saved his tooth and he was pain free upon awakening.