Feline infectious peritonitis (FIP) is a viral disease that until recently was untreatable and almost always fatal in cats. An effective antiviral drug emerged a few years ago but was legally unavailable in the United States. Some cat owners bought the drug at high cost on the international black market, but this product was unregulated, untested, and possibly unsafe.
 
A compounded version of this antiviral drug, GS-441524, is now available in the United States by veterinary prescription. This means that FIP has become a treatable disease instead of a near-certain death warrant for cats.
 
The US Food and Drug Administration (FDA) hasn’t officially approved the compounded product for use in cats. However, the FDA announced that because no approved drug is available, it won’t enforce drug approval requirements when a veterinarian prescribes this product for an individual cat.[1]
 
Signs and Diagnosis of FIP
The virus that causes FIP is a coronavirus. Feline coronavirus infection is very common in cats. The virus typically lives in the intestines without causing much trouble. In some cats, feline coronavirus mutates into a disease-causing strain that spreads through the body. This disease is FIP.
 
The signs of FIP depend on whether a cat has the “wet” form (with fluid accumulation in the chest and abdomen) or the “dry” form (with inflammatory masses and other changes in the eyes, nervous system, kidneys, liver, or other organs). Some of the signs are swollen belly, decreased appetite, decreased energy, weight loss, fever, labored breathing, blindness, and seizures.
 
Because the signs of FIP are nonspecific and because so many cats have been infected with feline coronavirus, diagnosis is not simple. The diagnosis is often presumptive, meaning that it’s not confirmed by definite tests but is suspected on the basis of clinical signs and the results of blood and urine tests, imaging studies, fluid analysis, and biopsy.
 
Treatment
GS-441524 is a metabolite of remdesivir. Remdesivir is used to treat COVID-19 in humans, but it’s not licensed for use in animals. Veterinarians can treat animals off label with drugs licensed for humans, so remdesivir is technically a treatment option for cats but it’s hard for veterinarians to access.
 
Unlike remdesivir (an injectable product), compounded GS-441524 is a tuna-flavored tablet. It’s already being used to treat cats in Australia and the United Kingdom. The dose depends on the cat’s clinical signs, and the current recommendation is to continue treatment for 12 weeks.
 
Reported survival rates for cats treated with GS-441524 range from 81% to 100%.[2] Without this treatment—or a similar antiviral drug if one becomes available—the prognosis is grim.
 
References
1. FDA announces position on use of compounded GS-441524 to treat FIP. US Food and Drug Administration. May 10, 2024. Accessed September 3, 2024. https://www.fda.gov/animal-veterinary/cvm-updates/fda-announces-position-use-compounded-gs-441524-treat-fip
2. Tasker S, Addie DD, Egberink H, et al. Feline infectious peritonitis: European Advisory Board on Cat Diseases guidelines. Viruses. 2023;15(9):1847. doi:10.3390/v15091847
 
Image source: https://unsplash.com/photos/gray-tabby-kitten-leaning-on-white-wall-VwqecUsYKvs

Cleaning the litter box might not be your favorite chore, but it has a major benefit: it helps you monitor your cat’s health. Some serious illnesses that are common in cats affect their toileting behavior, urine output, and stool consistency. By scooping the litter box a couple of times a day, you can find evidence of these problems much sooner than you would if your cat toileted outdoors.
 
Signs to Watch For
Contact your veterinarian if your cat shows any of these signs:

• Change in frequency of litter box visits
• Urinating or defecating outside the litter box
• Squatting in the litter box without producing much urine (a medical emergency in male cats)
• Crying in the litter box
• Change in size of urine clumps
• Blood in urine or stool
• Change in stool consistency
• Change in stool volume

 
You don’t need to use specialty products like color-changing cat litter (marketed as a health screening tool) to detect problems. If you decide to try cat litter that changes color according to pH or other chemical factors, keep a couple of cautions in mind. First, be sure your cat is willing to use the litter. The right kind of litter is whatever kind your cat is comfortable with. For most cats, this means unscented litter that is scooped daily and replaced regularly. Second, don’t rely on the litter to rule out a medical problem. Color-changing litter can’t be used for diagnosis and might not be accurate even for screening. If your cat shows signs of a problem but the litter’s color indicator hasn’t changed, contact your veterinarian anyway.
 
What Urine and Stool Changes Might Mean
Toileting Behavior
Cats tend to hide signs of illness and pain, so we need to watch for subtle behavior changes as clues to medical problems. Visiting the litter box more often might be caused by increased urinary urgency, increased urine volume, or diarrhea. Visiting the litter box less often could indicate arthritis, other mobility problems, stress, general illness, or competition from other pets. Urinating and defecating outside the litter box have lots of possible medical causes, so don’t assume your cat is just being spiteful (cats don’t feel that kind of emotion).
 
Urine Clumps
When you scoop the litter, pay attention to the size of the urine clumps. Clumps getting bigger over time could mean that your cat’s urine volume has increased. Kidney disease, diabetes, and thyroid disease are all common in cats and cause increased urine volume. A decrease in size or number of urine clumps might mean that your cat is urinating somewhere else in the house. Male cats with urinary blockage (a life-threatening emergency) produce no or very small amounts of urine.
 
Stool
Signs of urinary problems (like straining or frequent squatting in the litter box) can be mistaken for constipation. Cats with constipation produce either small hard stools or no stools. Soft stool and diarrhea are more common than constipation in cats and have many possible causes. If your cat has soft stool that lasts for more than a day, blood in the stool, or small hard stools, contact your veterinarian. Save a sample of stool that’s less than 24 hours old in case your veterinarian needs it for testing.
 
Image source: https://www.flickr.com/photos/134294785@N06/21911087653/

A hands-on physical examination is a valuable part of annual wellness visits as well as sick-animal visits. Examinations during wellness visits often uncover problems that weren’t obvious at home. That is the point of a wellness exam: we want to find problems early, before they become more serious and harder to treat. Wellness exams also let us track an animal’s changes over time. For sick animals, the physical exam is a crucial part of the diagnostic workup.
 
Not all veterinary visits involve a full physical exam. Recheck visits typically include assessment of only a single area (like the ears). And high-volume, limited-service settings like vaccine clinics generally don’t offer full physical exams.
 
A veterinarian can often complete a physical exam within a few minutes, so you might not realize how much information your veterinarian is gathering by looking at, touching, and even smelling your pet. The following basic assessments are part of a comprehensive physical examination.
 
Breathing effort, mental status, posture, gait, general appearance, and reaction to clinic environment: The veterinarian assesses these elements before ever touching the animal. These items are clues to the urgency of a sick animal’s condition and also tell us an animal’s overall state of health, basic neurologic status, and anxiety level. If an animal without an urgent medical problem shows signs of significant fear and anxiety in the clinic, the veterinarian might stop the examination at this point and recommend returning another day with previsit antianxiety medication.
 
Temperature, pulse, and respirations (TPR): The TPR is part of the standard vital sign assessment, along with mucous membrane color and capillary refill time (assessed with a quick touch of the gums). Some animals object to rectal thermometers, and other types of thermometers aren’t always accurate, so the veterinarian might skip temperature measurement for a well animal.
 
Eyes, ears, nose, and oral cavity: Dental disease is very common in dogs and cats, and external ear disease is common in dogs. These problems are often first noticed during wellness exams. The veterinarian might or might not use an ophthalmoscope and otoscope to examine the eyes and ears, depending on the animal’s clinical signs and comfort level (inserting an otoscope into an inflamed ear canal could be painful).
 
Chest: The veterinarian listens to the heart and lungs with a stethoscope to check heart rate and rhythm, identify abnormal heart sounds like murmurs, and assess lung sounds.
 
Abdomen: Gentle palpation of the abdomen can reveal discomfort and possibly abnormal size of individual organs.
 
Musculoskeletal system: The veterinarian assesses muscle mass, especially in senior animals that might have arthritis, and checks the joints for common problems like patellar luxation. Animals that are limping receive a more comprehensive orthopedic examination including range-of-motion tests of multiple joints unless this would be too painful without sedation.
 
Skin and lymph nodes: The veterinarian looks for external parasites like fleas, evidence of itching (saliva staining of the paws, for example), hair loss, signs of skin infection, skin lumps, mammary gland masses, and enlarged lymph nodes. Skin problems are very common in dogs and cats and often turn up during wellness examinations. Many skin problems need further diagnostics, such as looking at a sample of cells through a microscope.
 
Neurologic system: For well animals with no signs of neurologic disease, the veterinarian assesses basic neurologic function and mental status. A more comprehensive neurologic examination includes tests of nerve function of the head and limbs. For animals with neck or back pain, the veterinarian carefully palpates the spine to pinpoint the location of the pain.
 
Urogenital system: Male dogs that have not been castrated have their testicles checked. They might also have rectal palpation to evaluate the prostate. Female dogs and castrated male dogs get a quick glance at the external genitalia and receive a more thorough examination if they have signs of a problem.
 
Image source: https://www.flickr.com/photos/armyrotc/52943246855/

Have you ever heard that pregnant people shouldn’t handle a cat’s litter box? This is because of the risk of toxoplasmosis. World Zoonoses Day, July 6, is a great time to talk about how this disease passes from animals to people and whether pregnant people really do get a 9-month pass on cleaning the litter box.
 
Zoonoses are diseases that are transmitted from nonhuman animals to humans. Toxoplasmosis is a zoonotic disease caused by infection with the protozoan parasite Toxoplasma gondii. Toxoplasmosis is one of the most common foodborne illnesses in people.
 
The people who should be most cautious about T gondii infection are those with compromised immune systems and those who are pregnant.
 
Toxoplasmosis in People
People With Healthy Immune Systems
People with healthy immune systems usually have no signs of T gondii infection and don’t know they’ve been infected. For those who develop signs, most have swollen lymph nodes or flu-like symptoms that get better on their own within a few weeks. Much less commonly, the infection can affect the eyes and cause vision loss.
 
Whether or not the initial infection causes any signs of illness, the parasites remain in the body in a dormant state. The infected person develops immunity to T gondii. However, if the person’s immune system becomes compromised (because of chemotherapy, organ transplantation, or AIDS, for example), the T gondii organisms are reactivated and cause illness.
 
People With Weakened Immune Systems
In people with compromised immunity, toxoplasmosis affects the brain, eyes, lungs, and other organs. Either a new infection or a reactivated infection can cause seizures, confusion, and coordination problems.
 
Fetuses Infected Before Birth
A fetus won’t become infected if the mother was infected with T gondii before getting pregnant. In this case the mother already has immunity and won’t pass the infection to the unborn child (as long as she has a healthy immune system).
 
If a mother is infected for the first time during or immediately before pregnancy, the fetus can be infected too because the mother doesn’t yet have immunity. Most people don’t know if they’ve been infected with T gondii in the past, so it’s safest for all pregnant people to take precautions to avoid infection.
 
The consequences of infection in an unborn child can be severe. The pregnancy might end in miscarriage or stillbirth, or the fetus might develop anatomic abnormalities. More commonly, infected infants have no signs of infection when they’re born. These individuals can develop vision loss or neurologic problems years later.
 
How People Are Infected

• Foodborne transmission: eating undercooked meat or shellfish; drinking contaminated water or unpasteurized goat milk
• Zoonotic transmission from cat feces: swallowing the parasite after handling cat litter and not washing hands; consuming produce contaminated with cat feces (for example, eating unwashed vegetables from a garden that a cat has used as a latrine)
• Transmission from newly infected mother to fetus
• Blood or organ donation from infected donor (rare)

 
Toxoplasmosis in Cats
Domestic cats and other felines are the only species that spread T gondii into the environment. Cats become infected after eating birds or rodents that have T gondii cysts in their bodies. Infected cats then shed T gondii oocysts (eggs) in the stool. The oocysts are not infective to other animals right away. After at least 1 day, the oocysts mature to a stage that can infect other animals. Infective oocysts can survive in the environment for years.
 
Most infected cats don’t have any signs of illness. Cats with compromised immune systems can develop disease similar to that of humans with compromised immune systems.
 
Identifying cats infected with T gondii is tricky. Cats shed oocysts in the stool for only a short time, so fecal tests aren’t reliable for diagnosing infection in cats. However, if a fecal test happens to show oocysts that look similar to T gondii, the cat’s owners should take precautions with the cat’s stool for a few weeks. A blood test showing that a cat has T gondii antibodies doesn’t tell us whether that cat is likely to start shedding oocysts that could put the family at risk.
 
Precautions
The CDC recommends these precautions to avoid toxoplasmosis:

• Cook meat and fish to an internal temperature high enough to kill T gondii organisms.
• Rinse fruits and vegetables.
• Don’t eat raw or undercooked shellfish or drink unpasteurized goat milk.
• Follow hand and kitchen hygiene precautions (wash with soap and water).
• Wear gloves when gardening; wash hands after handling soil that a cat might have defecated in.
• Cover outdoor sandboxes so cats don’t use them as giant litter boxes.
• Don’t feed cats raw or undercooked meat.
• Scoop the cat litter box daily; it takes more than 1 day for oocysts in the stool to become infective.
• See this CDC page for more: https://www.cdc.gov/toxoplasmosis/prevention/index.html

 
Pregnant people should also take these precautions:

• Have someone else clean the litter box if possible. If you need to handle the litter, wear disposable gloves and wash your hands afterward.
• Keep cats indoors to prevent them from hunting animals that might be carrying T gondii cysts.
• Don’t handle stray cats or kittens while you’re pregnant.
• Don’t get a new cat while you’re pregnant.

 
For More Information

• Toxoplasma gondii, Companion Animal Parasite Council website: https://capcvet.org/guidelines/toxoplasma-gondii/
• Toxoplasmosis, Centers for Disease Control and Prevention website: https://www.cdc.gov/toxoplasmosis/about/index.html

 
Image source: https://www.cdc.gov/dpdx/toxoplasmosis/index.html

Environmental enrichment means modifying an animal’s living space to encourage physical activity and allow the animal to engage in behaviors that are natural for its species. For indoor pets especially, environmental enrichment improves physical and mental health and can reduce behavior problems.
 
Dogs and cats with mobility problems need environmental modification for accessibility and mental stimulation. Pets have mobility limitations for a variety of reasons:

• Arthritis or other medical conditions that cause joint, bone, or muscle pain
• Frailty from advanced age
• Neurologic conditions that affect balance and coordination
• Decreased vision
• Recovery from surgery
• Activity restriction as part of medical treatment

For these pets, thoughtful environmental enrichment can reduce stress and increase quality of life.
 
Household Modifications and Physical Activity
Cover hard floors with nonslip mats or rugs. Consider using lots of small washable mats instead of large rugs for easier cleaning if your pet urinates or defecates on the floor (common in animals with medical problems, mobility limitations, or cognitive decline). Be sure to have a nonslip surface in front of your pet’s food and water bowls.
 
Use steps and ramps. Think of all the places your pet likes to be that are not the floor—bed, sofa, cat tree (climbing structure), window seat, and so forth—and make sure your pet can get up and down without jumping. You might need to train your pet to use steps and ramps by leading them with treats.
 
Cats need to scratch for claw health and their mental health (it’s normal species behavior). Reaching and stretching can be difficult for cats with arthritis, so offer your cat horizontal as well as vertical scratching surfaces.
 
Ask your veterinarian about exercise that’s appropriate for your pet. Depending on the medical condition, your pet might benefit from controlled gentle exercise. Some veterinary facilities have physical rehabilitation equipment like underwater treadmills.
 
Toileting
Difficulty reaching the toileting area causes anxiety for animals. For cats, put low-sided litter boxes on every floor of the house in quiet, accessible areas. Cats tend to be most comfortable toileting in big open boxes (at least 1.5 times the length of the cat, not including the tail). A large plastic storage bin makes a great litter box; cut an opening on one side so your cat can walk in and out easily.
 
Dogs with new mobility problems or cognitive decline might not give you their usual cues that they need to go out. If your dog or cat starts having toileting accidents indoors, make a veterinary appointment to check for a medical reason. If no medical cause is found, your pet might be having trouble getting outside or to the litter box.
 
Mental Stimulation
Engage your pet’s senses: use toys with different odors, textures, and sounds. Puzzle feeders and treat-dispensing toys engage the brain and encourage physical activity. Teach your old dog or cat new tricks. Use positive reinforcement to train new behaviors that don’t require a lot of movement (like touching their nose to your hand).
 
For dogs with mobility problems, walks aren’t really about walking. Just seeing and smelling the outdoors is valuable mental enrichment for dogs. Take your dog out on a harness and forget about actually getting anywhere; be patient and let him sniff and wander at his own pace. If your dog can’t walk easily, carry him or use a wagon.
 
Give your cat a soft seat by a window if possible. Your cat might also enjoy cat-friendly videos.
 
For More Ideas
Home modifications. International Cat Care. 2024. Accessed June 18, 2024. https://icatcare.org/app/uploads/2024/03/Changes-to-the-home-environment_ISFM-caregiver-guide_FINAL.pdf
 
Sueda K, Cho J. Environmental enrichment for senior dogs and cats. Clinician’s Brief. December 2017. Accessed June 18, 2024. https://www.cliniciansbrief.com/article/environmental-enrichment-senior-dogs-cats
 
Image source: https://unsplash.com/photos/black-cat-on-white-cat-tree-X7OokuRyvCI

If your cat vomits, don’t assume it’s because of hairballs (or just because he’s sitting on an expensive rug). Vomiting has lots of possible causes, and some are serious. A mistaken belief that vomiting is normal for cats can delay diagnosis and treatment.
 
When to Seek Veterinary Care
Many cats vomit occasionally, just like dogs and people. Some cats vomit frequently, and these cats need an examination and diagnostic tests. “Frequently” means different things for different cats, but in general, cats that vomit more than about once a month should see a veterinarian. These are some other signs that a vomiting cat needs veterinary care:

• Increased frequency of vomiting
• Decreased appetite
• Decreased activity
• Weight loss
• Increased or decreased urine volume (change in size of urine clumps in litter box)
• Increased frequency of urination
• Increased thirst
• Constipation or diarrhea
• Meowing more often than usual or crying in the litter box
• Behavioral signs of discomfort: hiding, avoiding people or other animals, playing less than usual, sleeping more than usual, being grumpy or aggressive

 
Vomiting or Coughing?
Respiratory problems in cats can be mistaken for vomiting. Coughing can look a lot like hacking up a hairball. Asthma is common in cats, and the hunched posture and raspy breathing of an asthma attack can look and sound very similar to retching.
 
True vomiting means forcefully expelling stomach contents from the mouth. Hacking up food or a hairball is vomiting. Hacking up a little bit of foam is harder to interpret. Signs that the problem is with the lungs or heart instead of the stomach include open-mouth breathing, wheezing, and increased sleeping respiratory rate (more than 30 breaths per minute while asleep).
 
It’s OK if you can’t tell if your cat is vomiting or coughing. Take a video to show your veterinarian and make an appointment as soon as you can; lung and heart problems shouldn’t wait.
 
Causes of Vomiting
Vomiting has too many possible causes to list here. These are some of the most common in cats:

• Metabolic diseases: kidney disease, diabetes, hyperthyroidism, liver disease, cancer, etc
• Digestive tract disorders: inflammatory bowel disease, intestinal lymphoma, megacolon, etc
• Foreign objects: string, rubber bands, etc
• Hairballs
• Intestinal parasites
• Infectious diseases
• Poisonous plants, toxins, human food, medications, etc
• Intolerance to food ingredients

 
Diagnostic Tests
The tests chosen depend on the cat’s history, signs, and physical examination findings. Cats with chronic vomiting typically undergo a series of tests until the cause is found. Baseline laboratory tests include bloodwork, urinalysis, and stool tests for parasites. Radiography (x-ray imaging) can show some of the problems that cause vomiting; ultrasonography is more useful for others. Inflammatory bowel disease and some other intestinal disorders are diagnosed with biopsy of the intestine, which requires general anesthesia.
 
Treatment
The type and duration of treatment depend on the cause. Foreign objects and hairballs that are blocking the intestine are removed surgically. Some problems can be treated with a single course of medication; others require lifelong treatment. If your cat resists oral medication (pills or liquids), tell your veterinarian so you can explore alternatives.
 
Image source: https://unsplash.com/photos/a-gray-cat-sitting-on-top-of-a-rug-ybibgcEcv2w

Cats need access to food, water, shelter, and litter boxes. We can consider these their essential needs to survive; however, they also need means to express typical species behavior like hunting, viewing, climbing, scratching, and playing. Enrichment enhances our cat’s environment by giving them chances to express these behaviors. This can improve their mental and physical well-being and even reduce unwanted behaviors. Any changes in routine can be stressful for cats and any new activity or changes in environment are recommended to be done slow and steady.
 
Different Types of Enrichment
Food puzzles/foraging toys: Food puzzles are a great way to increase your cat's activity and mental stimulation. There are a variety of commercially made food puzzles like Doc and Phoebe’s mice, sniffle mats, Trixie puzzle feeders, etc. Some of these are stationary and others cats have to move around to get food out of them. You can also make your own using cardboard boxes, towels, toilet paper roll, etc. When introducing your cat to any food puzzle, recommend starting easy then building up to more challenging puzzles.
 
Toys: Cats have a natural instinct to hunt and we can use this instinct to get them to play. Cats typically like mice, bugs, and birds as prey when they live outdoors. With this in mind, using toys that mimic the feel, sound, or movement of mice, bugs, or birds can entice cats to play more. Some examples are wand toys with feathers or faux fur OR cat dancer toys (mimic a bug). It is best to rotate toys so they do not lose interest (ideally every few days).
 
Clicker training: Cats can be trained to do a variety of tricks (sit, high-five, lay down, etc) or go through an obstacle course. Clicker training can even be used to help you medicate your cat (with appropriate training). Recommend getting a clicker with a ball at the end (this can be purchased online).
 
Sensory enrichment: Videos of mice, birds, or fish can be stimulating for cats (YouTube videos). Or set up a bird feeder outside near their favorite window with a window perch. For their sense of smell and need to chew, catnip or silvervine or cat grass can be stimulating for them. Outdoor walks or screened-in porches are great sources of enrichment for cats as well (please ensure this is under supervision).
 
Environmental enrichment (cat trees, scratchers, and more): One of the cat’s essential needs is shelter, which includes a safe place to sleep and rest; however, this also includes a place to have time alone or get away from people or other animals. This is where cat trees or other vertical spaces can be very useful. It also creates areas where you can have playtime or feed them or use it as part of an obstacle course. Another important behavior/need cats have is scratching. This is important for their nail health. Many cats have preferences of the material and vertical versus horizontal. I recommend trying out the different options. There are a variety of other cat furniture ideas you can use for enrichment, such as shelves, tunnels, window perches, etc. Consider changing the positions or locations of any of these to renew their interest.
 
Check out these resources for more ideas regarding feline enrichment:

• https://www.catschool.co/clicker-training-cats-all-your-questions-answered/
• Fundamentally Feline by Ingrid Johnson
• Ohio State University Indoor Cat Initiative
• “Play With Your Cat” by Mikel Delgado on her What a Cat Wants blog
• http://foodpuzzlesforcats.com/

Urinary tract disorders are common in cats. Feline lower urinary tract disease (FLUTD) is a general term that describes disorders of the bladder and urethra. A number of disorders cause FLUTD, so cats with any changes in urination or litter box behavior need to see a veterinarian.
 
Signs
Cats with FLUTD have similar signs regardless of the underlying cause:

• Frequent urination
• Straining to urinate (can be mistaken for constipation)
  Note: for male cats, straining without producing more than a few drops of urine is a medical emergency.
• Crying in the litter box
• Urinating outside the litter box
• Blood in the urine
• Overgrooming around the urethral opening (can cause hair loss under the tail)
• Nonspecific signs of cat discomfort: decreased activity, decreased appetite, grumpiness

 
Causes
Idiopathic Cystitis
The most common cause of FLUTD is idiopathic cystitis. Idiopathic means “of unknown cause,” so this condition is diagnosed when tests don’t reveal another cause. Chronic stress appears to be a major risk factor. An abnormality of the bladder lining could also be involved. Idiopathic cystitis is managed rather than cured. The signs tend to come and go over time. Flare-ups often improve on their own regardless of treatment, which makes it hard to tell if a particular treatment has actually had any effect. Cats with idiopathic cystitis are treated with stress-reducing measures like environmental enrichment and antianxiety medication. Some cats benefit from other medications or special diets.
 
Urinary Tract Infection
Urinary tract infections are uncommon in young and middle-aged cats. Cat urine is normally so concentrated that bacteria can’t easily survive in it. However, diseases that affect urine concentration and chemical composition (like kidney disease and diabetes) are very common in older cats, so cats in this age group are much more likely to have urinary tract infections. A diagnosis of urinary tract infection requires urinalysis and ideally a urine culture to identify the specific bacteria. Older cats with urinary tract infections should also have bloodwork and radiography or ultrasonography of the abdomen to find the underlying cause. Bacterial urinary tract infections are treated with antibiotics, ideally chosen according to culture results.
 
Uroliths (Bladder Stones)
Uroliths are rocklike mineral collections that form in the bladder or any other part of the urinary tract. Uroliths are found with radiography or ultrasonography. Some types of uroliths can be dissolved with a prescription diet; others require surgical removal. Even the dissolvable types often need to be removed surgically because they can be painful, cause infection, and block the urethra of male cats. Uroliths that form in a kidney or ureter (the tube connecting the kidney to the bladder) usually warrant referral to a veterinary surgery specialist.
 
Urethral Obstruction
Urethral obstruction is a life-threatening condition in which a urolith or mucus plug blocks the urethra. Male cats are at much higher risk than female cats because male cats’ urethras are narrower and longer. Cats with urethral obstruction initially have the same signs as cats with FLUTD from any other cause. If the obstruction isn’t removed, the bladder becomes large and painful and can rupture. The kidneys can no longer function normally, and the cat can die of toxin buildup and electrolyte imbalance. Cats with urethral obstruction need emergency care and usually at least a few days of hospitalization.
 
Other Causes
Cancer, injury of the spinal cord or urinary tract, and anatomical problems with the urinary tract can also cause FLUTD.
 
Image source: https://unsplash.com/photos/black-and-white-cat-lying-on-brown-bamboo-chair-inside-room-gKXKBY-C-Dk

Arterial thromboembolism (ATE) in cats has a guarded to poor prognosis and a high mortality/euthanasia rate. In ATE, a blood clot forms in the heart, travels through the circulation, and lodges in an artery. The clot blocks blood flow through that artery, causing significant pain and tissue damage. When the clot blocks an artery supplying a limb, as is usually the case, the limb becomes weak or paralyzed.
 
The most common site for ATE in cats is the aorta at the point where it divides into smaller arteries that supply the rear legs. A clot stuck here takes on the shape of a saddle, so ATE in this location is called a saddle thrombus.
 
Cats with a saddle thrombus have sudden extreme pain and paralysis of the rear legs (usually both rear legs but sometimes just 1). Witnessing their pain and distress can be quite upsetting to their caretakers.
 
Cause
ATE is usually caused by heart disease. Unfortunately, a saddle thrombus can be the very first sign that a cat has heart trouble.
 
The most common type of heart disease in cats—and thus the most common cause of ATE—is hypertrophic cardiomyopathy, an abnormal thickening of the heart muscle. Hypertrophic cardiomyopathy is most common in senior cats but can also affect younger cats. An estimated 15% of all cats and up to 29% of senior cats have hypertrophic cardiomyopathy.[1] Of these cats, a reported 11.3% develop ATE within 10 years after diagnosis.[2]
 
Signs
Signs of ATE usually appear suddenly. A cat with ATE will cry loudly in pain and might vomit. The cat will drag the affected limb or be unable to walk. The affected limb might feel cool to the touch.
 
If the cat’s underlying heart disease has progressed to heart failure, the cat might also have signs like panting or rapid breathing.
 
Diagnosis
ATE can usually be diagnosed with a physical examination. The affected limb is typically cool, the nail beds are bluer or paler than those of the other paws, and the pulse in that limb is absent or weak. A heart murmur might be present. Diagnostic tests can be used to rule out other possible causes, especially if the cat has less obvious signs caused by a partial blockage.
 
Treatment
Many cats with ATE are euthanized before treatment is attempted. Factors linked to a better prognosis include involvement of only 1 limb, ability to move the affected limb, and absence of heart failure (meaning that the heart disease has not yet progressed to the level of heart failure).
 
For cats that receive treatment, the immediate priority is pain control. They also receive anticoagulant medications (blood thinners), treatment for shock and tissue damage, and treatment for heart disease. Cats that don’t have heart failure and survive the first few days in the hospital have a chance of regaining the use of the affected limb once the clot dissolves.
 
Prevention
For cats known to have heart disease, certain findings on echocardiography (heart ultrasound) can indicate an increased risk for ATE. These cats can receive preventive anticoagulant medications. However, many cats with heart disease have no obvious signs, so their heart disease isn’t diagnosed.
 
References
1. Luis Fuentes V, Abbott J, Chetboul V, et al. ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats. J Vet Intern Med. 2020;34(3):1062-1077. doi:10.1111/jvim.15745
2. Lo ST, Walker AL, Georges CJ, Li RH, Stern JA. Dual therapy with clopidogrel and rivaroxaban in cats with thromboembolic disease. J Feline Med Surg. 2022;24(4):277-283. doi:10.1177/1098612X211013736
 
Image source: https://unsplash.com/photos/gray-tabby-cat-FilM6ng7VGQ

Many dogs and cats experience fear, anxiety, and stress at the veterinary clinic. Their anxiety often begins before they even arrive at the clinic, especially if they associate pet carriers and car rides with the clinic. Previsit antianxiety medications for pets can make clinic visits easier and safer for these pets, their owners, and clinic staff.
 
These are some of the benefits of previsit medications for anxious pets:

• Less stress at the clinic
• Better acceptance of future clinic visits
• Less stress for car rides
• Less need for restraint by multiple staff members
• Increased ability to have diagnostic procedures and treatments
• Increased safety for patients for whom stress and struggle are risky (for example, patients with heart disease, respiratory disease, frail condition, or brachycephalic head shape [flat face])

 
Previsit medications have benefits for pet owners and clinic staff members too. Being the caretaker of an anxious and fearful pet isn’t easy, so previsit medications for pets can reduce everyone’s stress levels. For clinic staff members, managing patients’ clinic anxiety reduces the risk of injury and decreases workplace stress (we love animals too and don’t want to cause them distress).
 
How to Know if Your Pet Needs Previsit Medications
Previsit medications aren’t just for aggressive animals. Pets with more subtle signs of stress are scared too, and they deserve help for their anxiety just as much as animals that can’t be handled without full sedation.
 
If your pet shows obvious signs of fear at the clinic, you probably already know that your pet would benefit from previsit medications. But maybe your pet’s signs are not as noticeable and you’re a little surprised when your veterinarian recommends medications.
 
Dogs and cats show anxiety and fear with a range of behaviors and body language cues. Anxious and fearful dogs and cats tend to start with subtle behaviors like lip licking or freezing. If the scary thing doesn’t go away—or tries to draw a blood sample—the behavior can escalate to aggression.
 
Dogs and cats that are anxious at the veterinary clinic can show these signs:

• Hiding
• Refusing to leave the carrier
• Freezing
• Yawning, lip licking (dogs)
• Pacing
• Panting
• Trembling
• Hard stare or side eye
• Struggling
• Growling, hissing, snarling, barking
• Swatting (cats)
• Warning snap
• Biting

 
How to Use Previsit Medications
Previsit medications work best if they’re used along with training and positive reinforcement. For example, a cat can make positive associations with the cat carrier if the carrier is left out all the time as part of the normal household furniture, sometimes with yummy treats inside, instead of appearing only when the cat is going to the clinic.
 
Veterinarians choose previsit medications according to the needs and medical condition of the individual patient. Some of the drugs commonly prescribed for situational (short-term) anxiety are gabapentin, trazodone, and clonidine. Motion sickness contributes to anxiety, so pets might also receive antinausea medication. Some of these medications can cause sedation, but the main goal is anxiety reduction, not sedation.
 
Previsit medications are timed to have maximum effect at the time of the clinic visit. They need to take effect before the pet experiences any stress. Most of these medications are given at least 1 to 2 hours before the clinic visit; sometimes a loading dose is also given the night before. They typically last for up to 8 hours, although the duration can vary.
 
Because individual animals respond differently to these medications, giving a trial dose can be very helpful. If you use a trial dose, tell your veterinarian how long it took for the medication to take effect, how the medication affected your pet’s behavior, whether your pet had adverse effects like vomiting or excessive sedation, and how long the medication’s effects lasted.
 
For some dogs and cats, previsit medications aren’t enough to overcome their fear. These pets might also need a sedative injection at the clinic. For these pets, previsit medications given at home make the sedative injection easier for the pet (and staff) and can also reduce the dose of injectable drug.
 
Image source: https://unsplash.com/photos/a-white-cat-sitting-inside-of-a-cage-B-_SyRxv2So