Acupuncture Handout

History

The word acupuncture comes from Latin meaning acus "needle" and punctura "prick" The technique is most commonly recognized as a part of Traditional Chinese Medicine. The use of acupuncture in China date back at least 3000 years. In China the healing art of acupuncture has been practiced on animals for centuries. The Chinese practiced acupuncture on horses then gradually tried it on other farm animals and finally dogs, cats and birds. Acupuncture was brought to Europe in the 1600’s but was not widely used in the west until the after 1972 when President Nixon visited China and the “bamboo curtain” was lifted.

The Theory

In Traditional Chinese Medicine the acupuncture healing work is based around “Qi” - the “Life Energy”. “Qi” is said to flow around the body in meridians or channels and acupuncture serves to unblock Qi energy and boost the immune system which aids in self-healing. Acupuncture points lie on the meridians and are areas of the skin at which the flow of Qi can be affected. In China acupuncture developed under influence of different philosophies like Taoism and Naturalism and the concepts of Yin and Yang and “The Five Elements” - Wood, fire, earth, metal and water. In Western Medicine acupuncture is used as a therapy following orthodox clinical diagnosis and the acupuncture points are chosen based on neurophysiological principles. In Western terms, acupuncture can assist the body in healing itself by affecting certain physiological changes. For example, acupuncture can stimulate nerves, increase blood circulation, and relieve muscle spasms, and cause the release of hormones, such as endorphins (one of the body's pain control chemicals) and cortisol (a natural steroid). Although acupuncture's physiological effects have been studied, much is still unknown.

How does it work?

The effect of acupuncture needling is mediated through stimulation of the peripheral nervous system and the effect can be local, segmental or general. Acupuncture causes release of hormones, endorphins and other “messagers” in the body and stimulates wound healing, antiemesis, immunomodulation and pain modulation. Local needling of trigger points, tender points and acupuncture points is used in treating somatic pathology and segmental needling is used to enhance the effect or to treat visceral conditions

Side effects and safety

Acupuncture is considered one of the safest forms of medical treatment when it is administered by a properly trained person. However, it is possible to physically harm the patient through improper needling of a few points, but this should not happen with an experienced acupuncturist. Side effects of acupuncture are rare, but they do exist. An animal's condition may seem worse for up to 48 hours after a treatment although this is rare. Other animals may become sleepy or lethargic for up to 24 hours after acupuncture. These effects are the indication that some physiological changes are developing, and they are most often followed by improvement in the animal's condition. The worst thing that may happen is nothing. That is, no change in the patient's status as a result of the acupuncture treatment.

Is acupuncture painful?

The needles that are use for acupuncture are very fine needles and for small animals, the insertion of acupuncture needles is virtually painless. Once the needles are in place, there should be no pain. Most animals become very relaxed and may even become sleepy. Nevertheless, acupuncture treatment may cause some sensation, presumed to be those such as tingles, cramps, or numbness which can occur in humans and may be uncomfortable to some animals.

How long do acupuncture treatments last and how often are they given?

The length and frequency of acupuncture treatments depends on the condition of the patient and the method of stimulation that is used by the veterinary acupuncturist. Stimulation of an acupuncture point may take as little as 10 seconds or as much as 30 minutes. A simple acute problem, such as a sprain, may require only one treatment, whereas more severe or chronic problems may need several treatments over a longer periode. The treatment intervals will vary with different conditions. Routinely treatment will be recommended given once weekly until results are observed (usually 2-6 weeks) then start increasing the time interval until we find how long your pets' condition can go between treatments. The maximum intensity of treatments would be 2-3 times per week in acute severe conditions. On the average you can expect anywhere from 2 months to 4 months between treatments once results have been achieved. The nature and severity of the condition is the determining factors. The number of points or needles used during a treatment will also be determined by the condition and the response to earlier treatments.

For which conditions is acupuncture indicated?

Acupuncture should never be administered without a proper veterinary diagnosis and an on going assessment of the patient’s condition and response to any prior treatment. Acupuncture as a treatment is not an alternative to surgery for such conditions that require surgical treatment, but can be used alone or in addition to medical treatment to treat certain conditions. Following surgery, it can improve the patients’ comfort level and speed up the postoperative recovery period. In some cases, it may reduce or eliminate the need for chronic medication. In veterinary medicine, there is evidence of the success of acupuncture for treating disorders of the musculoskeletal, neurological, pulmonary, gastrointestinal, reproductive and dermatologic systems.

The most common conditions that are treated;

• Musculoskeletal problems, such as arthritis, hip dysplasia, tendonitis or intervertebral disk disease
• Chronic pain caused by degenerative joint disease
• Traumatic nerve injuries
• Skin problems, such as lick granulomas and allergic dermatitis
• Respiratory problems, such as asthma, rhinitis, chronic coughing, or pneumonia
• Gastrointestinal problems, such as diarrhoea or vomiting
• Certain neurological disorders Certain reproductive and endocrine disorders
• Some urinary disorders.

 

Obesity

Obesity occurs when a pet eats more calories than it requires on a daily basis. The excess calories are converted to fat, and the fat is laid down in the body tissues. Just as obesity has become a more important medical condition in people, so also pets are being affected. Pets share our lifestyles. They eat food provided in bowls that they do not need to hunt for. They live in our comfortable, temperature-controlled homes and do not need to look for suitable places to sleep. Most pets are provided with plenty of snacks and they just have to look longingly at us, to be supplied with a treat or more food. Animals are not like us in that they do not care what they look like, so have no desire to sort out the weight problem by dieting and exercise.

The problems with this lifestyle and the resultant obesity are:

1. True obesity, where the pet is considered 40% or more over the ideal body weight, is a clinical condition, which requires careful weight reduction under veterinary guidance.
2. Disinclination to move more than they have to or to do any exercise.
3. More weight means more pressure on the joints and an increased risk of osteo-arthritis.
4. Arthritis causes an animal to want to move even less, which results in a further increase in weight.
5. A shorter lifespan due to the higher risk of medical conditions, such as:
   • lower immunity
   • hormone imbalances
   • mammary tumours
   • infertility & dystocia
   • skin problems
   • urinary problems
   • diabetes
   • constipation
   • liver disease in cats
6. Increased risks during anaesthesia and surgery. Surgery times are lengthened due to increased adipose tissue at surgery sites.
7. The cardiovascular and respiratory systems are affected, causing increased risks of high blood pressure, exercise intolerance, breathlessness, collapsing tracheas.
8. Increased insulation from the fat layer causes increased body temperatures in hot climates.

Some pets are more likely to become obese and need to have their weight closely monitored from a young age. Dogs, such as Labradors, cocker spaniels, Shetland sheep dogs, amongst others, tend to become obese. Pedigree dogs are also more at risk than crossbreeds, while crossbreed cats are more at risk than pedigree cats. Female dogs and male cats that are kept in apartments have an increased risk. Overweight puppies and kittens are more inclined to be obese adults as they are not only used to overeating, but they also have a higher number of fat cells than they were born with – fat hyperplasia. As animals become older and less inclined to play like young animals, tend to become more obese. Some hormonal conditions and medications can also cause obesity.

Prevention of Obesity

Pets that are predisposed to obesity should be weighed on a regular basis from a young age. Owners can weigh their pet at home at least once a month, or take the pet to the vet to be weighed more accurately. An adult animal should not fluctuate more than 5% of their body weight. Neutered animals have a greater chance of becoming obese, as they require 15% less calories after neutering. Therefore pets that have been neutered should get a slight reduction in the calories. This can be done by changing to a diet that is specifically for neutered animals. Pets should get some form of exercise every day. Dogs should be walked or played with every day. Cats in apartments or homes with no access to the outdoors should be played with and encouraged to move. It is difficult to take a cat for a walk as they get stressed when removed from their usual territory. Wild cats were used to hunting and running to keep their weight down. Companion cats kept in Hong Kong apartments to not get this opportunity and are much more likely to become obese. The best prevention of obesity is being aware of your pet’s size and not giving excessive treats or overfeeding.

Treatment of Obesity

There are two main areas of treatment: exercise and diet. There are a couple of ‘diet pills’ available now from vets for animals, but exercise and diet remain the best treatments. Exercise Obese animals need to start off slowly with exercise. Remember that obese pets have compromised cardiovascular and respiratory systems. They may have more painful joints and their joints have to work harder as they carry more weight. Obese pets should see a vet before beginning an exercise regime, so that the vet can advise the ideal exercise and the ideal amount of exercise for that particular animal. Walking, running and playing are the most common forms of exercise. Swimming is excellent for obese pets, as the water keeps the temperature of the animal down and swimming does not cause any pressure on the joints. Diet Obese pets need very carefully balanced diets. Home made meals or table scraps tend to contain too much fat and salt. Commercials pet foods also contain high levels of fat, as fat makes food more palatable. Prescription Obesity diets will contain a higher percentage of fibre. This means that the animal will not need to drastically reduce the amount of food given. This is a great advantage as it prevents the animal from getting hungry between meals, and starting to beg or scavenge for food. If weight loss is attempted by just reducing the amount of food, the pet will also get a reduced amount of proteins, vitamins and minerals. This can lead to deficiencies and health problems. Reducing the amount of food triggers a slower metabolism, as the body tries to ‘conserve’ fat, so no weight is lost unless the metabolism is boosted by increased exercise. Obesity diets are especially formulated diets that provide the pet with sufficient proteins, mineral and vitamins. They contain L-carnitine, which is a vitamin-like substance that is beneficial to weight loss. They contain an increased level of high quality protein, which promotes muscle mass maintenance, and added minerals and vitamins to compensate for energy restrictions. The antioxidant complex limits cell degradation caused by free radicals and strengthens the immune system. The increased fibre content does not provide any calories to the body as it remains in the gastro-intestinal system and is not digested and absorbed. Increased fibre does increase the amount of stool produced. Owners need to watch out for diarrhoea developing if the pet is changed onto obesity diet too quickly. The pet’s system will not be used to the higher percentage of fibre, unless the diet is introduced slowly.

Aiding our pet’s weight loss

We suggest you join our Weight Loss Consultation Program. The program itself only costs the initial veterinary consultation, any medications required, a suggested diet and your time. Initial Vet Consultation One of our vets will examine your pet, take the temperature, pulse, respiration rate and blood pressure. The vet may advise x-rays, if they feel the pressure of the fat compromises the organs of your pet. The vet may also suggest joint x-rays if your animal is showing any lameness or reluctance to move. This way we can find any health or arthritic changes early. We can supply you with supplements for your pet to help with joint pain and slow the rate of arthritic changes. We can discuss any health problems and the best way to deal with them while your pet is losing weight. The vet will work out the target weight for your pet, the amount of food to be fed daily, and the amount and type of exercise that will be most beneficial. We will keep all your pet’s information in our computer system, so that we can accurately monitor your pet’s weight loss and health. Weekly Weigh-in We suggest that you bring your animal into the clinic on a weekly basis. We will book a nurse consultation appointment for you. The nurse will weigh your pet and check the temperature, pulse and respiration rate. If you have any problems or queries, you can raise these with the nurse. If she cannot answer the query herself, she will ask a vet to ensure that you get the right answer. These nurse consultations do not cost anything, unless there was a medical problem, such as high blood pressure, discovered during the initial vet consultation, which needs further monitoring or care. Once your pet is responding well to the program, we can reduce the weekly weigh-ins to monthly weigh-ins. When your pet has reached its target weight, we can advise you how to maintain your animal at that weight, so that all your hard work is not for nothing.

 

Feline Infectious Anaemia (FIA)

A disease that causes many problems in Hong Kong is Feline Infectious Anaemia. This is an often-fatal disease of red blood cells (RBC). There are three different causes of this disease, although only one is present in Hong Kong. In the USA and South Africa certain protozoa, Babesia and Cytauxzoon, are causes, but here a bacteria, Mycoplasma haemofelis, cause it.

Mycoplasma haemofelis is small, primitive bacteria without a cell wall. Two strains exist, with some variation in symptoms depending on which one infects the cat. These bacteria attach themselves to the RBC. They can only grow in cat's blood, and cannot be cultured, or survive outside of blood. The RBC are damaged by the bacteria, which cause them to rupture. The body also produces antibodies against the damaged RBC. These antibodies may also attack healthy RBC. RBC with antibodies are removed by the immune system. This leads to severe anaemia. The blood loss follows a pattern: RBC with bacteria appear for 1-2 days, followed by a period of about 6 days during which the blood is cleared of bacteria by the immune system.

Cats which recover from the infection will still have bacteria present, possibly lifelong. Generally these cats have low levels of bacteria, and the body can produce RBC as rapidly as the bacteria damage them, so that no symptoms are noticed. The symptoms can recur again, though, if the balance is lost - for instance, if the cat is stressed, has another disease or has drug suppressing the immune system. It is clear, therefore, that, as with many serious diseases, the role of the cat's immune system in causing serious symptoms is very important. In Europe and the USA almost 50% of all cases involve cats with Feline Leukemia Virus or Feline Immunodeficiency Virus (Cat AIDS). Most cases we see in Hong Kong are after serious disease or major surgery.

The method of transmission of the disease is not well understood, as the bacteria are only found in the blood. Kittens can already get the bacteria from their mothers, either in the uterus or possibly through milk. Blood transfusions or cats swallowing blood can transmit the disease. It is also thought that blood-sucking insects, such as fleas, transmit the disease. Catfights may also be a source. Once a cat has the disease it probably does not cause problems immediately - stress or illness are usually needed to trigger the symptoms.

Symptoms are poor appetite, weight loss and depression, with fevers every few days and pale mucous membranes. Symptoms are often missed initially or interpreted as signs of the illness that 'triggered' the FIA. Most cats are diagnosed only in the late stage of disease. To confirm diagnosis, an experienced veterinarian may identify the bacteria on a blood smear, though they are easily confused with other RBC changes. Testing for bacterial DNA is available, but not in Hong Kong at present.

Any cat, which has anaemia of unexplained cause, should be treated for FIA, as blood smear will only be positive during the 1-2 day period, then negative for 6 days. Treatment is often difficult and long courses of antibiotics are needed. Many antibiotics attack bacterial cell walls and are therefore not effective against Mycoplasmas. At present 2 groups of antibiotics, Tetracyclines and Fluoroquinolones, have had effect. Both groups have potential side effects, especially at the high doses needed. Several other drugs have been used, but often with poor success. Corticosteriods can help to reduce blood loss, by 'switching off' the immune system and slowing down the blood loss to give the antibiotics more time to have effect. In our experience, response to treatment is slow. Often several different drugs must be tried, and this can be frustrating to owners. Most cases have happy endings eventually, however.

To prevent this disease, cats should be kept as stress free as possible.. Not too many cats should be kept in a household as this causes social stress. Male cats should be neutered to prevent fighting. Vaccinations should be kept up to date, and careful attention paid to flea control, to prevent 'trigger' diseases, or opportunities for transmission.

 

Rabies in the Cat

Cats are susceptible to rabies as are all warm-blooded animals. Cats are more resistant than dogs to experimental infection with some canine rabies isolates, but much more prone to developing rabies to some isolates from wild animals. Younger cats are more susceptible than older cats

The transmission of rabies from one animal to another is by the infected animal’s saliva or central nerve tissue entering an open or fresh wound or coming into contact with mucous membranes of the nose. Rabid cats will generally attack from a hidden dark place when disturbed. Although dogs account for the most human rabies exposures in the United States, these are on the decline due to strict vaccination and animal control programs. Disturbingly, there has been an increase in the number of human rabies exposures attributed to rabid cats.

Incubation in the cat is influenced by the age of the bitten animal, the number of nerves in the area of the bite and the distance of the bite from the spinal cord or brain. The rabies virus will spread to the central nervous system via the nerves. Incubation in the cat can be anything between 2 and 24 weeks, but generally around 4 weeks. Incubation in humans can be anything between 3 weeks and 1 year.

Symptoms of rabies:

Initial symptoms – cats will have fever spikes and show unusual or erratic behaviour for only 1 or 2 days.

There are then two main different types of symptoms that occur:

• Furious: Cats more consistently develop this stage first within 1-7 days after the first clinical signs. The cat develops increasingly erratic and unusual behaviour. Cats have been reported to develop anxious, staring, wild, spooky or blank looks in their eyes. When confined, they will make vicious, striking movements and attempt to attack anything that moves. Then they develop muscle tremors, weakness or incoordination. They may also try to run continuously until they die of exhaustion.
• Paralytic: this stage in the cat generally develops after the furious stage from about the fifth day. It begins with initial paralysis of the bitten extremity that then develops to paraparesis; and incoordination develops into ascending or generalized paralysis, ending in coma and death. Cats do not tend to develop the laryngeal and facial muscle paralysis seen in rabid dogs, but the tend to vocalize more and they may have a change in pitch of vocalization.

There are atypical, abortive forms of rabies virus infections that recover, but these cases are rare.

Due to the range of atypical symptoms, the diagnosis of rabies virus infection is very difficult. There are no definitive diagnostic tests that are sensitive enough for consistently reliable diagnosis. Rabies should be considered in any animal developing profound behavioural changes or features of paralysis or both. A comprehensive history is very important in making a diagnosis.

If rabies is strongly suspected, immediate euthanasia is strongly recommended. Supportive therapy is not recommended, as not only does it put handlers at risk, but also cats that recover from rabies can still excrete rabies in their saliva for extended periods. Extreme care must be taken when handling all suspected rabies cases.

There is no standard rabies immunization in Hong Kong at present. Most domestic cats are kept in enclosed areas and are very unlikely to come into contact with a rabid animal. Cats that regularly come into contact with other unknown animals or cats should be considered a slightly higher risk and immunization should be considered. Cats that are taken to shows or transported overseas are generally vaccinated for rabies.

If your cat is bitten by a suspected rabid animal, the following procedures should be followed:

• The case must be reported to the Department of Agriculture, Fisheries and Conservation either by yourself or by the veterinarian in charge of your cat.
• If your animal has been immunized and has a current immunization (i.e. been vaccinated within the last 3 years), your cat must be vaccinated immediately and kept under your control, away from other animals, for at least 45 days. During this time you should watch your cat carefully for any signs of rabies.
• Non-immunized cats or cats whose rabies vaccination has lapsed should either be euthanased immediately or quarantined in a secure enclosure (e.g. a government quarantine kennel) for 6 months and then vaccinated 1 month after release.

If a person is bitten by a suspected rabid animal, they should see their doctor immediately and also make sure that the case is reported to the Department of Agriculture, Fisheries and Conservation.

Desexing cats

Many people in Hong Kong still think that it is not necessary to desex cats. There are many reasons why desexing is essential in all cats that are not chosen for breeding.

Firstly, which cats can be used for breeding?
In general, the quality of purebred cats in Hong Kong is very poor genetically, and we see a much higher percentage of cats here with serious genetic diseases such as cardiomyopathy, polycystic kidney disease, and less serious disorders such as stenotic nares. This shows that unless purebred cats here have certified breed records, showing their parents and grandparents did not carry these poor genetics, they should not be used for breeding. In first world countries, kennel clubs and breed associations will monitor and control breeding. There is no reason why Hong Kong breeders should be allowed to continue breeding and selling unsuitable cats.

There is a great shortage of potential owners of cats, and apart from pre-bred cats, there are also many abandoned cats needing homes. This shows that breeding should be restricted.

It is important to remember that by keeping cats as pets we have removed them from their natural habitat. They need to adapt to this unnatural state. In the wild, cats are solitary and territorial. Female cats have to very little contact with males and will attract males from great distances to mate. They will normally only breed once a year. This allows their bodies to recover from the severe stress and weight loss that having kittens causes.

If entire males and females are kept together in a confined area, they will instead mate at every opportunity. They can easily have up to three litters a year, but the loss of condition will make the female very susceptible to infections and eventual death.

Male cats that are constantly exposed to females on heat, who they can smell for several kilometers, will lose interest in food. They will try to escape to track down the female. They will fight with other males to establish dominance. Entire males are much more likely to wander from their homes, which exposes them to many risks. They are more likely to get feline leukaemia, feline aids, septicaemia and other consequences of fighting. They usually eat less and are thinner and in worse condition than neutered cats. Most male cats will ‘spray’ – mark their territory – and their urine smell is much stronger and more unpleasant than compared to neutered males. They are more likely to develop ‘stud tail’, which is a greasy skin condition especially at the tail base. They are also more likely to be aggressive.

Apart from the dangers of ‘unwanted’ pregnancy, female cats that are never bred from almost always develop uterine problems in middle age. The common problems include cystic endometrial hyperplasia, mucometra and pyometra, which may lead to death if not treated. Treatment is by spaying anyway, but often when the cat is a higher anaesthetic risk, than when a young healthy cat.

The incidence of mammary tumours in unsprayed cats is also much higher. 80% of these tumours are malignant and no treatment is available to prevent metastasis, so it is wise to prevent this disease.

In conclusion, desexed animals that have no sexual urge are calmer in temperament, less frustrated by confinement and not inclined to wander or escape. Desexed animal are much healthier than cats, which are entire but not used for breeding.

Bladder Problems in Cats

Cats have a tendency to suffer from bladder problems. Most of these problems need long-term management to prevent recurrence. It is very important to diagnose the cause of the problem accurately so that effective long-term management can be planned.

Irrespective of the cause of bladder problems, the symptoms tend to be the same: inflammation of the bladder leading to frequent urination; straining and pain during urination; and the urine may be cloudy or may contain blood. In male cats, blockage of the urethra can easily result in the over expansion of the bladder and even rupture of the bladder, with a buildup of toxins, which can lead to death within a few days.

Inflammation of the bladder has several causes. There are three main causes, though: struvite bladderstones; oxalate bladderstones; or interstitial cystitis. Other causes such as bacterial bladder infections and bladder tumours are occasionally found, but these are common only in old or immunosuppressed cats. Systemic diseases such as liver failure or other metabolic abnormalities can lead to crystal or stone formation in the bladder, but this is not common.

Bladderstones or crystals:
Crystals form in urine when the urine is over saturated with certain chemicals, which can no longer remain dissolved and therefore crystallize into solid particles. Aggregates of these particles will eventually form stones. Urine contains many different chemicals, and whether these crystals remain dissolved or crystallize depends on many factors. The excretion of crystal-forming substances by the kidneys is affected by the amount of these substances in the blood (and therefore in the animal as a whole) and the normal or abnormal function of the kidney.

The amount of water in the urine (or concentration) will affect these substances. This depends in turn on the amount of water the animal drinks, and the ability of the kidney to concentrate the urine.

The acidity (pH) of the urine is also very important, as certain chemicals can remain dissolved at a certain pH but if the pH changes they will crystallize.

Other interactions between chemicals and the temperature also play a role but since these tend to be consistent, are generally ignored. All these previously mentioned factors affect not only whether crystals form, but also the rate of formation and the structure of the crystals.

Struvite crystals: These are the most common crystals found in Hong Kong cats. They are formed by a mixture of magnesium, ammonia and phosphate. Unlike dogs, where these stones usually form during bladder infections, in cats these crystals tend to form continuously as the kidneys excrete excessive amounts of these three chemicals. Small stones, like grains of sand, form, which cause inflammation of the bladder. The pus and damaged bladder cells glue these crystals together into plugs, which easily block male cats urethras. A blocked bladder is always an emergency requiring surgery to unblock the bladder and hospitalization to treat the toxic effects. Prevention by strict diet is usually effective. Diets must be low in magnesium, phosphate and nitrogen (which forms ammonia), which mean lower protein levels, as protein is the main source of nitrogen. High water content, or diets that encourage drinking will also decrease the concentration of these chemicals. The pH of the urine is very important. A low pH (acidic) urine will prevent the formation of struvite crystals.

Calcium oxalate crystals: This is most common type of crystal in cats in the USA, but it is still fairly rare in Hong Kong. Small amounts of these crystals are found normally in cat’s urine, but large amounts may occur with high blood calcium or oxalate. However most cases of stone formation is in cats with normal blood calcium, and is caused by increased calcium and oxalate excretion, decreased citrate excretion (citrate prevents these crystals forming), acidic and concentrated urine. These factors are genetic and so this condition is more common in purebred cats. As long as no disease is present causing high blood calcium, prevention of these crystals is by diet. Canned diets are essential. They must be low in oxalate and calcium, high in citrate, low in protein and sodium and not make the urine too acidic. Diets, however, cannot completely stop these crystals forming, as the underlying cause is often genetic, but they can reduce the frequency of bladder problems.

Interstitial Cystitis: This is the common name for inflammation of the bladder of unknown cause. Inflammation of the bladder occurs without crystals, bacteria or any other known causes being present. Pus and blood are present in the urine, and urination is painful and frequent. While symptoms may be severe, they usually resolve within a few days. Mild cases may recur only a few times a year, but some cases, inflammation may be almost permanent. Stress is believed to play a role, and some researchers believe viruses, such a herpes virus, or abnormal forms of bacteria not visible under the microscope, may be involved. We do know that in most cases, cats respond to certain drugs usually used for behavioural problems (antidepressants). These may decrease stress, as well as relax the bladder muscle and reduce inflammation symptomatically in the bladder. Although these drugs control this form of bladder inflammation effectively, until the cause is found, no cure will be available. It has been noticed that diets to prevent urine crystals also decrease the frequency and severity of the symptoms, so these cats also need to be on a strict diet.

Almost all bladder problems in cats are long-term or recurring, so long term management is essential. Correct diagnosis is necessary to find the correct diet, and where necessary, medical and surgical treatment.

Caring for the Orphan Kitten

Housing Kittens need to be kept in a draft-free enclosure with soft warm absorbent bedding. As kittens are unable to regulate their body temperature when they are very young, care must be taken to keep the kittens warm. Newly born kittens should be maintained in an ambient temperature of about 32C for the first week. Normally kittens will have a mother to cuddle up to, to help maintain the correct temperature. An orphan kitten will therefore need a hot water bottle or something similar. The kitten must be able to move away from the heat source, as if it becomes overheated, it will become dehydrated. Maintaining the correct temperature and at least 50% humidity is not difficult in Hong Kong, but care must be taken not to put the kitten in an air-conditioned room. After 1 week, the hot water bottle can be removed as the kitten can be kept in a room temperature of 27C, reducing to a room temperature of 24C from the fourth week onwards.

As orphan kitten either did not get colostrums (concentrated milk with antibodies) from their mother or only got a limited amount, the kittens will have a low natural immunity to infectious diseases. The kitten, therefore, needs to be kept in an especially clean and hygienic environment. The bedding needs to be cleaned regularly and sanitized. All feeding equipment also needs to be cleaned and boiled after use. Kittens should not be allowed to come into contact with any other older animals. The person who is handling and feeding the kitten should wash their hands before touching the kitten. The kitten should be cleaned twice a week with a soft moistened cloth to simulate the kitten’s mother’s tongue.

Socializing
The kitten should be handled regularly and briefly. Handling socially stimulates the kitten, allowing it to increased its brain development and improve weight gain. As the kitten gets older it can be handled more, and be allowed to play in a bigger area.

If there is more than one kitten they can be housed together, but care must be taken that the kittens do not start suckling on each other. Suckling can lead to skin abrasions and make the kitten vulnerable to infection. Housing kittens together will also help to maintain their body temperature. If kittens look very similar, nail polish can be used on the toenails to differentiate kittens from one another, so that kittens do not get missed out by accident when being fed or cleaned.

Feeding
The growing kitten not only needs food to maintain weight, but also to grow. They must also eat more than they excrete. Because of this, the growing kitten is more sensitive and vulnerable to an inadequate or imbalanced diet. Growing kittens need 2-3 times the food requirement of an adult of the same weight. If feeding is incorrect, poor conformation will result.

Cow's milk is not suitable for kittens as it has too much lactose and too little protein, fat, calcium and phosphate, when compared to queen’s milk. Cow’s milk can cause diarrhoea in kittens. We recommend that specialized feline reconstituted milk (e.g. Walthams Kitten Nursing Support) be used, as this diet is correctly balanced for kitten and is very easy to use.

The energy requirement of a new born kitten is 380kcal/kg, which reduces to 250kcal/kg after about 4 weeks. But most specialized kitten milk has a recommend daily allowance which is easy to follow. Newly born kitten should be fed every 2-3 hours for the first week. After the first week the kittens can be fed every 4 hours for the next 2 weeks. Thereafter they can be fed every 5 hours until the kitten is eating semi-solid food.

The milk should be warmed to blood temperature (39C). The milk can be fed to the kitten by a doll’s bottle, an eye dropper or a syringe with a small piece of plastic tubing attached. Using a doll’s bottle with a nipple is the best method as the kitten will then regulate the food intake and there is no danger of overfeeding.
Overfeeding can be more dangerous to kittens then underfeeding. However, some kittens are too weak to suckle well or do not respond well to suckling from a bottle. In these cases a syringe or eye dropper is better to use. Care must be taken in these cases not to feed the kitten too rapidly, as the kitten can then aspirate the milk and get pneumonia, which generally results in death. The kitten should be held in a horizontal position during feeding with its head in a natural position. This will help to prevent aspiration as well.

If the kitten feels cold to the touch, the rectal temperature should be taken. If the rectal temperature is below 35C, do not begin to feed the kitten – it will not suckle and it will be unable to ingest the food. Warm the kitten up to at least 37C and then begin feeding.

Things to avoid
Cold food
Overfeeding
Rapid feeding rate
-these will result in regurgitation, aspiration, bloating and diarrhoea.

At four weeks of age you can start introducing the kitten to canned kitten growth diet. The kitten growth diet is added very slowly into the kitten’s milk and placed in a very shallow dish for the kitten to eat out of. The food must still be warmed to blood temperature. The kitten will get very messy initially as they tend to climb into the food with all four feet. You will still need to feed the rest of the milk to the kitten with the bottle,syringe or eye dropper. As the kitten gets used to the canned food, you can start to reduce the kitten milk and increase the canned food. The kitten must also receive more water at this stage to replace the fluids that it is no longer getting from the milk. The kitten needs to take in about 180ml per kg of water per day. Once the kitten is eating the canned kitten growth diet only, you can slowly start introducing a kitten growth dry diet. You must ensure that the kitten then has constant access to fresh water.

Urine and Faeces
The kitten will only gain voluntary control of the processes of urinating and defaecating at 3 weeks of age. Before that, the queen will stimulate the kitten to urinate and defaecate by licking the perineal area (under the tail). With the orphan kitten, the handler will need to use either a soft damp cloth or a small piece of moist cotton wool, to stimulate the kitten to urinate and defaecate. This should be done after every meal. If the kitten is not producing urine after every meal and faeces at least once or twice a day, the kitten needs to be seen by a veterinarian, to ensure that the kitten is well and is not constipated. If the kitten develops diarrhoea, the food volume should be decreased or diluted in more water. The kitten will need to be fed more often to maintain its body weight.

Health
The kitten needs to be checked initially for hypothermia, hypoglycaemia, dehydration and congenital defects. Thereafter it needs to be evaluated daily:
It should remain normally rehydrated.
It should sleep quietly between feeding.
It should gain weight – 100g per week.
It should be alert and become more and more active as it gets older.
It should be eager to suckle.
Its body temperature should be maintained between 37C and 39C
It should have normal regular stool.

If any irregularities develop, the kitten should be taken to a veterinarian as soon as possible.

Some additional points
The kitten’s birth weight should be between 90 and 120g. The weight should double during weeks 1 and 2 and triple between weeks 3 and 4. The average weight gain during the first 4 weeks should be 10-13g per day.
The kitten’s eyes should open between 5-14d.
The kitten’s ears will react to auditory stimulation at 3d but will only get functional hearing at 21d.
The kitten will begin to walk unsteadily at 21-22 days and will start to climb at 31 days – at this stage you may need to cover the kitten’s housing, to prevent the kitten escaping.
The kitten will develop milk teeth at 2 – 3 weeks.

Coughing Cats

Coughing is not a common symptom in cats. Unlike dogs, there are only limited causes for coughing in cats. In Hong Kong, where most cats live indoors, cats are not exposed to many causes of coughing.

Outdoor cats are more likely to be exposed to infections and parasites that may cause throat or lung infections. Indoor cats are more likely to be susceptible under certain conditions.

Overcrowding is the most important:
Cats are solitary animals by nature, and their immune systems are not designed to be exposed to constantly high levels of infectious agents such as viruses and bacteria. If several cats live in close confinement, the chances of infection spreading between cats is very high. Overcrowding is also very stressful, which reduces their immune systems. Pedigree cats may already have poor immune systems, especially if inbred. This means that many cats in Hong Kong are at risk.

Environmental factors:
Environmental factors also may weaken the immune system of the trachea and lungs. Cats are especially susceptible to smoke and inhaled particles. These may directly damage or inflame lung tissues, but also damage the immune cells in the lungs. The immune cells cannot then fight infections. Cold, dry air may reduce the functioning of the immune system – one reason that colds and influenza are more prevalent in winter among people. Pollution levels are often higher in winter in Hong Kong.

Viral Infections:
Herpes and Calicivirus are very common, causing upper respiratory and eye infections. They are, however, very unlikely to cause tracheal infections unless the cat is immunosuppressed, such as cats with Feline Leukaemia Virus or Feline Aids. They do predispose the cats to secondary bacterial infections which may be serious

Bacterial Infections:
Bacterial infections are the most common cause of tracheal and lung infections. They do usually need predisposing factors to cause infections, such as a primary viral infection or environmental factors as previously discussed. They will often also cause nasal and eye infections. Mycoplasmas, Chlamydia and Bordetella species are the most common. Bordetella is rapidly becoming resistant to many antibiotics, and this will cause problems in treatment.

Protozoal and Fungal infections:
Although these can cause lung infections in other regions, these would be unusual in Hong Kong. One exception is Cryptococcus, a fungus found worldwide, which causes sinusitis in immune-suppressed cats and can spread to cause meningitis or pneumonia.

Worms:
The larvae of common intestinal worms migrate through the lungs and into the trachea, causing coughing. Several species of lungworms, which live in the bronchi, exist, but probably not in Hong Kong. Heartworm is common in Hong Kong dogs, and can affect cats. The blood tests used in dogs for diagnosis are not useful in cats, so diagnosis is difficult. A high-resolution ultrasound to see the worms in the heart and blood vessels is necessary in most cases.

Foreign bodies:
Pieces of string or grass trapped in the nasal passages or around the base of the tongue are quite common in cats. A careful examination of the throat under anaesthesia using an endoscope may be necessary to find these foreign bodies.

Allergies:
“Asthma” is a possible cause of lung disease in cats, as cats are susceptible to inhaled pollutants. To confirm the diagnosis, samples from the throat need to be taken and examined for eosinophils (a type of white blood cell). It must be noted that identical cells may be found in cats with heartworm of other lungworm infestations.

Cancer:
Nasal polyps (tumours) can irritate the throat. Lung cancer is a relatively common type of cancer in cats. Primary lung cancer is most likely, although metastasis of mammary cancer, for instance, is also possible. Usually this will cause difficult breathing rather than coughing.

Conformation defects:
Physical defects such as a long soft palate or laryngeal defects are possible, especially in short faced breeds such as Persians.

It is important to remember that lung diseases not affecting the upper respiratory tract in cats, such as heart failure, cancer and lung abscesses, will not cause coughing, unlike these conditions in people and dogs. Coughing is unlikely to be caused by potentially fatal diseases unless the cat is also experiencing difficult or laboured breathing.

Owners can reduce risk by being aware of environmental factors:
Not overcrowding Castrating male cats to prevent wandering and fighting Most importantly, keeping vaccinations up to date.

I would also recommend routine vaccination against:
Chlamydia, as out breaks are becoming more frequent Feline Leukaemia, as this is also becoming more prevalent.

Summer problems in cats

One of the most common reasons for cats being brought to the vet is because of teeth and gum infections. Almost every cat will suffer from these infections at some stage. There are many different causes for these infections although the symptoms may be the same.

Owners often do not notice until the disease is advanced, as animals will continue to eat, even if painful. Owners should look in their cat’s mouths every few months. Signs to look for are: dirty teeth, especially tartar (hard yellow crusts covering the teeth); redness of the gums, initially as a red line by the teeth but later throughout the mouth; salivation; gums which bleed easily; and loose or painful teeth. Symptoms that usually develop in severe cases include decreased appetite, slow or painful chewing, scratching at the mouth, salivation, blood in the mouth, and crying when the mouth is opened.

Causes of gum and tooth infections:
Bacterial infections:
The mouth is full of bacteria normally. These bacteria produce chemicals helping them to stick to the teeth. This forms a sticky, slimy layer on the teeth called plaque. With time, minerals in the saliva and food become incorporated in the plaque, and a hard yellow material forms on the teeth, called tartar. Plaque and tartar are filled with bacteria. Toxins from the bacteria will attack the tissues surrounding the teeth, initially causing inflammation of the gums. The gum eventually retracts and exposes the tooth roots. These toxins then enter the sockets and eat away the bone and tissues holding the roots. The tooth may finally be lost and the bone infected.
These common infections can be treated with antibiotics, but unless the teeth are cleaned and the damaged teeth removed, the infection will recur.

Root neck lesions:
A very painful problem found only in cats, which causes loss of teeth. These are not infections, although secondary infections will usually occur. The affected tooth root is eaten away by tissues that are normally only found in kittens. These tissues eat away the roots of baby teeth, thereby causes them to fall out. It this tissue survives in the mouth of the adult cat, it will also start to eat away the roots of the adult (or permanent) teeth. The tissues make holes in the teeth and eventually cause the loss of the teeth.
The only treatment is removal of affected teeth.

Viral infections:
Two viruses in particular are involved.
Calici virus causes deep, round ulcers on the tongue and palate. This can stop infected cats eating and drinking. Other symptoms include high fever, joint pains, eye infections and nasal infections. This is usually only found in kittens or unvaccinated cats.
Herpes virus can cause similar symptoms, although the ulcers tend to be smaller and the fevers less severe. Cats can still get Herpes virus in spite of vaccination, although in a milder form. However, these can lead to lifelong infections. Households with many cats, or purebred cats, are especially susceptible.
Treatment usually consists of drugs to stimulate the immune system to suppress the virus, and supportive treatment.

Immune mediated gum diseases:
This is usually the most severe form of gum inflammation. This disease when the body’s immune system, designed to attack infections, will start to attack its own tissues, in this case the gums. This can be triggered by long-term infections, such as those mentioned above. The most common underlying infection is probably herpes virus. In other countries Feline Leukaemia Virus and Feline Immunodeficiency Virus are also commonly involved. These viruses are relatively rare in Hong Kong.
Correct diagnosis by biopsy, combined with tests for underlying diseases, is essential for successful treatment. The treatment depends on drugs to suppress the immune system, but this increases the chance of the underlying infections becoming worse. Permanent treatment with a variety of different drugs tailored to each individual case is usually necessary.

Other conditions, such as kidney failure and cancer can also lead to mouth infections. Most mild cases of gum infections can be treated by good dental care. More complicated cases may need intensive initial treatment and long-term drugs for successful control.

Desexing cats

Summer in Hong Kong brings heat and humidity. These changing environmental conditions can lead to increased incidence of certain diseases. At present we are seeing many skin, eye and respiratory infections.

Many cats are moulting at the moment. This is natural and usually happens twice a year in spring and autumn. However, many cats moult constantly, and the seasonal change is not quite as obvious. Even so in a cat with good coat condition, each hair follicle will produce two hairs a year. The hair will grow for a period until they are at full length, then stop growing for several months. They are then lost when the new hair grows from underneath. Cats that are sick or stressed may moult earlier. But if there is no baldness or itching, this does not mean there is a skin problem.

Allergies are more common in summer. One of the common symptoms is itching, which means that cats spend more time licking themselves. This is often mistaken for grooming. Cats usually only start scratching when the itching is severe. Often crusts will form on the skin, or secondary infections will form.

The most common allergies are flea and pollen allergies. Food allergies are not affected by the seasons. In hotter weather, fleas breed quicker and adult fleas live shorter but more active lives. Flea eggs can remain dormant in the environment for several years, waiting for good conditions. So the first warm, humid weather, which is ideal for fleas, can often lead to an explosion in flea populations, triggering flea allergies in susceptible animals. Animals that are allergic to pollens and fungal spores may also react to increased levels of allergens in this season. Allergies reduce the immune system of the skin and scratching may damage the surface of the skin. This makes these cats susceptible to secondary bacterial infections, which rapidly spread in hot, humid conditions.

All other skin infections, such as ringworm, infected scratches or wounds, may become more serious in this humidity. Clipping the hair short of cats with thick coats, but not shaving, will allow increased airflow at skin level.

Respiratory infections increase as the heat and humidity can affect the immune system of the windpipe. Animals with long term lung or heat problems may have worsening of symptoms.

Cats that are carriers of viruses such as Herpes or Calici, may have relapses during this period. Mild symptoms, such as sneezing or increased tears, usually clear up without treatment within 7-10 days. If the cat is tired, has a poor appetite or if the eyes are painful or inflamed, the cat will need treatment.

Cats with eyelid problems, like infolded eyelids, ‘dry eye’ due to long term eye problems, or large eyelids with prominent eyes leading to increased tear evaporation, are also more prone to eye infections at this time. Short-faced cats, such as Persians, are more at risk. Heat stroke is uncommon in cats. Cats that are kept indoors with high temperatures can rapidly die as they have a poor ability to reduce body heat. Panting, usually seen as quick, shallow breaths, is the main way to lose heat. This is not very effective, especially in short-faced cats. More importantly, cats will look for a cool place, such as a cool tiled floor or near an air conditioner. If there is no cool area, the cat may be in trouble!
Most summer problems can be avoided with common sense. Brush daily, keep the coat short and provide a cool area for the cat to get away from the heat.

Blood Pressure Problems

Has your pet ever had its blood pressure checked?

Most people will answer ‘No’, as very few vets offer this service. However, when a person goes to a doctor, measuring blood pressure is as routine as taking a temperature.

So why don’t most vets check your pet’s blood pressure?

The reason is simple – it is difficult! Because of the size and anatomy differences, until recently taking these measurements accurately was only possible with expensive equipment, and often involved placing catheters into veins. More recently, though, easier and accurate systems similar to those used in humans have been developed, although the equipment is still relatively expensive. With this new equipment, the blood pressure can be measured on the tail or the legs of animals.

Is blood pressure as important in pets as in people?

The answer is ‘Yes’. High blood pressure is common, especially in older animals, and is often an early indicator of disease. High blood pressure also causes the pet to suffer discomfort, lethargy, weakness, poor concentration (which may cause loss of housetraining, a change in personality or aggression) and headaches (these are difficult for the owner to assess).

High blood pressure can eventually lead to retinal damage, heart enlargement and failure, kidney damage, and other organ damage. There is an increased chance of blood clots, causing heart attacks and strokes.

What causes high blood pressure?

Certain breeds, male dogs and overweight dogs are more susceptible. Older cats are especially susceptible. Blood pressure is determined by heart output, amount of fluids in the blood vessels and blood vessel abnormalities. Many cases are due to obvious diseases, though some cases cannot be determined. 20% of cats with kidney disease have very high blood pressure. Most cases of heart disease and many hormonal problems (especially excessive thyroid hormone or cortisone production) also have a very high blood pressure. Treatment usually involves curing or controlling the underlying disease, if possible.

If no underlying disease is diagnosed, tablets to reduce blood pressure are effective. These tablets work usually by relaxing or dilating blood vessels and decreasing the force of heart contractions. Special diets are useful in mild cases too. Reduced salt diets, with reduced protein and phosphorus can help.

The animal’s symptoms should stop, making the pet more active and happier. More importantly, however, reduction of high blood pressure will protect against further organ damage, which can lead to blindness, brain damage and eventually death.