CARDIOMYOPATHY IN CATS

What is cardiomyopathy?

Cardiomyopathy is a term used to describe diseases of the heart muscle. In cats, at least three classes of cardiomyopathy have been described. In all cases, the heart disease may result in clinical signs of heart failure. Cardiomyopathy may be seen as a primary condition or secondary to other diseases.

What are the clinical signs seen with cardiomyopathy?

In the early stages of disease, the cat may be able to cope and hence show no signs of disease. This situation is referred to as compensated heart disease. Often the cats will alter their activity levels to those that they can cope with which makes it difficult to diagnose cardiomyopathy until it is quite advanced.

The major long-term concerns with all types of cardiomyopathy are:-

1.       Development of congestive heart failure:     Breathlessness and lethargy are the most frequently noticed signs of congestive heart failure and these result from a failure of the heart to efficiently pump blood.  Blood banks back into the blood vessels of the lungs, resulting in fluid accumulation in or around them.

2.       Thromboembolic disease:     Altered flow of blood in enlarged heart chambers predisposes to the formation of a blood clot within the chambers of the heart. This becomes organised and is known as a thrombus. If parts of the thrombus become dislodged they can travel in the bloodstream and become lodged in smaller blood vessels. These particles are called emboli and the most common place for them to lodge is at the bottom of the aorta which is the biggest artery in the body. This results in obstruction of the blood supply to the back legs which is usually very painful and the back legs become paralysed and cold to the touch. Although a minority of cats may recover completely with appropriate treatment, this is a potentially fatal complication of any cardiomyopathy. In some cats, a partial recovery which may take a long time is seen.

How is cardiomyopathy diagnosed?

Diagnosis of heart disease can be suspected on the basis of clinical signs, such as those of congestive heart failure, in addition to more specific tests such as chest x-rays. Electrocardiography (ECG) rarely provides useful information on heart conduction and size. Cardiac ultrasound scans, where available, are indispensable in distinguishing between the different types of cardiomyopathy.

Specific tests may be done in order to check that the cardiomyopathy is not secondary to some other disease. (see below).

What causes cardiomyopathy?

There are many causes of cardiomyopathy; however, in older cats thyroid disease (hyperthyroidism) may cause a type of cardiomyopathy. Other causes include dietary deficiency of taurine, an essential nutrient. This is not seen in cats fed a commercial cat food or fresh meat. Often, no cause of the cardiomyopathy is found.

How is cardiomyopathy treated?

In cases where an underlying cause of the heart disease is found, then treatment of this may result in improvement or reversal of the heart disease. Hyperthyroidism is the most treatable cause of cardiomyopathy since complete resolution of the heart disease is possible if treated early. In cases where no cause is identified, (referred to as idiopathic cardiomyopathy), and in cases where disease remains following treatment for an underlying cause then medication may be needed.

Treatment varies according to each case but may include:-

1.       Diuretics if congestive heart failure is present.

2.       Beta blockers to reduce the heart rate where this is excessive.

3.       Calcium channel blockers to help the heart muscle relax and hence help more effective filling of the heart.  These drugs are generally the most effective form of treatment and often are the only drug required (in the long term).

4.       Aspirin may be used for its effects at reducing the risk of thrombus formation and hence thrombo-embolic disease although it is being used less frequently these days for this purpose.  Dosing of asprin should always be as advised by a veterinary surgeon since aspirin may be toxic to cats.  Aspirin poisoning, which occurs if the dose or frequency of aspirin administration is too high, may cause vomiting and internal bleeding.  If your cat shows these signs, goes off their food or is sick then aspirin therapy should be stopped and you should consult your vet.

5.       ACE inhibitors - these drugs also help to control congestive heart failure.

The long-term outlook for a cat with cardiomyopathy is extremely variable depending on the cause of this disease. Cats with idiopathic cardiomyopathy may remain stable for several years and lead near-normal lives.

Does a cat with cardiomyopathy need a special diet? 

          Except in cases where taurine deficiency is suspected, no specific diet is recommended although       excessively salty foods are best avoided e.g. dry cat food and some cat treats, since these will predispose to fluid retention. This is because they can promote sodium retention, which increases the volume of fluid and therefore the volume of blood that the heart needs to pump. In some circumstances low salt diets may be recommended. This may increase the risk of congestive heart failure. Proprietary cat foods are usually adequate although special low salt diets are available and may be recommended by your veterinary surgeon in specific cases. Cat treats are often quite salty and probably should be avoided. Obese cats usually benefit from a controlled weight loss programme.

Testing for HCM?

Genetic tests are available for particular mutations which are recognised in the Maine Coon and Ragdoll breeds. However, not all cats with HCM will demonstrate these mutations. Therefore, a negative gene test does not rule out HCM (even in one of the aforementioned breeds). At present, the most accurate method for diagnosing HCM is the use of cardiac ultrasound (echocardiography). Go to Hypertrophic cardiomyopathy (HCM) in cats for more information on the gene test.

Kennel Cough

What is Kennel Cough?

Kennel cough, otherwise known as canine cough, canine croup, canine infectious tracheobronchitis, canine parainfluenza infection, canine Bordetella bronchiseptica infection and even, 'canine whooping cough' is a common respiratory disease affecting dogs, and related canine species, all around the world. Kennel cough is a highly contagious canine illness characterized by inflammation of the upper respiratory system. It can be caused by viral infections such as canine distemper, canine adenovirus, canine parainfluenza virus, or canine respiratory coronavirus, or bacterial infections such as Bordetella bronchiseptica. Kennel cough can be a highly infectious disease and spreads quickly among dogs, such as in the close quarters of a kennel. However, it is rarely serious when it strikes. Both viral and bacterial causes of kennel cough are spread through the air by infected dogs sneezing and coughing. It can also spread through contact with contaminated surfaces and through direct contact. It is highly contagious, even days or weeks after symptoms disappear. Symptoms begin usually 3 to 5 days after exposure. The disease can progress to pneumonia.

Pet owners are advised to give their dogs the right amount of care and attention that they deserve whenever they are sick with kennel cough. This is because Kennel cough may degenerate to a more serious health concern if not treated early on. Kennel cough in dogs can be likened to a mild case of influenza in humans.

The viral organisms implicated in canine infectious tracheobronchitis (including the ones we vaccinate against) are quite specific to the canine family of animals. These respiratory dog viruses do not tend to infect animal species outside of the canine family. For example, humans will not catch kennel cough viruses from their canine pets and nor will they pass on their own viral 'flus' to their dog.

Symptoms

The classic symptom of kennel cough is a persistent, forceful cough. Other symptoms include a harsh, dry hacking/coughing, retching, sneezing, snorting, gagging or vomiting in response to light pressing of the trachea or after excitement or exercise. The presence of a fever varies from case to case. The disease can last initially from 10-20 days and can re-break when the dog is put into a stressful situation which puts stress on the dog's immune system. Diagnosis is made by seeing these symptoms; having a history of exposure is also helpful but not always found, as kennel cough is easily spread through contact with contaminated surfaces such as the ground, toys, and sidewalks.

Some dogs with kennel cough may show other symptoms of illness, including sneezing, a runny nose, or eye discharge.

Dogs having kennel cough, probably will not lose their appetite or have a decreased energy level.

Treatment and prevention

Antibiotics are given to treat any bacterial infection present. Cough suppressants are used if the cough is not productive (nothing is being coughed up). Prevention is by vaccinating for canine adenovirus, distemper, parainfluenza, and Bordetella. In kennels, the best prevention is to keep all the cages disinfected. Most kennels will not board dogs without proof of vaccination.

CORNEAL ULCERS

Definition

The cornea is the transparent, shiny membrane which makes up the front of the
eyeball. Think of it as a clear window.  To understand a corneal ulcer,
you must first understand how the cornea is constructed.

The cornea is comprised of three layers. The most superficial layer is the
epithelium.  This layer is comprised of many very thin layers of
cells.  Below the epithelium is the stroma, and the deepest layer is
Descemetís membrane.  Because all of these layers of the cornea are clear,
it is not possible to see them without special stains which colour particular
cells and highlight them when looked at with a microscope. 

An erosion of few layers of the epithelium is called a corneal erosion or a
corneal abrasion.  A corneal ulcer is an erosion through the entire epithelium

and into the stroma.  If the erosion goes through the epithelium
and stroma to the level of Descemet's membrane, a descemetocele exists.
If Descemet's membrane ruptures, the liquid inside the eyeball leaks out, the
eye collapses and irreparable damage can occur.

Mechanism of occurance

There are several causes for corneal ulcers in dogs.  The most common is
trauma.  An ulcer may result from blunt trauma, such as a dog rubbing its
eye on the carpet, or due to a laceration, such as a cat scratch.  The
second most common cause is chemical burn of the cornea.  This may happen
when irritating shampoo gets in the eye.

Less common causes of corneal ulcers include bacterial infections, viral infections,
and other diseases.   These may originate in the eye or develop secondary to disease

elsewhere in the body.  Examples of other diseases include Epithelial Dystrophy (a
weakening of the cornea which can be  inherited in breeds such as the Boxer),

Keratoconjunctivitis Sicca (drying of the cornea due to abnormal tear
formation), which occurs in breeds such as the West Highland White Terrier and
diseases of the endocrine system (diabetes mellitus, hyperadrenocorticism, and
hypothyroidism).

The Andys Veterinary Clinics

The Andys Veterinary Clinic, Loresho, Nairobi

The Andys Veterinary Clinic, Ngong Road, Nairobi

The Andys Veterinary Clinic, Nyali, Mombasa

Euthanasia and Grief Management

Sometimes, after receiving a terminal diagnosis for a pet, the "waiting" time is the most painful time. Grief is a daily bittersweet experience and it is common for people, after receiving a terminal diagnosis, to experience a wide range of emotions. While grief is often considered to be something one experiences after the loss of a pet, it can also be experienced during this window of time during terminal illness.

Dealing with the loss of a pet is never easy. When dealing with euthanasia, or sudden loss due to an emergency illness or injury, the decisions that must be made and ultimate loss of the pet bring up a lot of conflicting and difficult emotions. When children are involved, special considerations must be made to help them understand what is going on and how to deal with pet loss and grief.

The five stages of grief include:-

1. Denial - This can't be happening to me/my pet!
2. Anger - Why me? This isn't fair!
3. Bargaining - If I could just have more time, find the best cure, do something to change the outcome.
4. Depression - The grief and sadness can be overwhelming.
5. Acceptance - My pet is now in a better place.

Guilt is often another component of this process; could the illness have been prevented or diagnosed earlier for a better outcome? Have all diagnostics and treatment plans been evaluated?
When faced with losing a beloved pet, it is wise and yes, very difficult, to not "mourn the living". If pain and other physical discomforts can be controlled with medications, our pets are much better equipped to "live in the moment", unaware of all that worries us.


Signs of grief in children - warning signs Children may take longer to grieve and "get over" the loss than adults. A short time of depression, acting out, or gloominess can be expected, and should go away. Longer periods or abnormal activity following loss should be addressed. Warning signs of severe or prolonged grief will vary significantly with the variables of child's age, relationship with the pet, emotional maturity, circumstances involved with the death, and so on.

General guidelines for recognizing grief in children:

• Not interested in usual activities, withdrawing from friends and family
• Eating considerably less than usual
• Reverting to pre-potty training or bed wetting
• Afraid of being alone or going to sleep, nightmares
• Preoccupied with thoughts of death

Talking about the death with the child is a good first step.

Moving forward - time to heal

• Remembering the deceased pet It is important never to belittle or ignore the child's relationship with the deceased pet. To say that it was "just a dog or cat, and we can get a new one tomorrow" does not address the child's grief or teach the child the importance of the human-animal bond. Children often have imaginaryfriends that warrant conversations and emotions - pets are real - they warrant true feelings and emotions too! It does not matter how small or "insignificant" the pet may seem to adults.
• Closure
  Having a burial, memorial, or similar ceremony helps to reinforce the importance of the pet's life and mark the death event. Children should be allowed to participate in whatever way is appropriate - helping mark the grave site, decorate the urn of ashes, or draw pictures of happy times together with the pet - whatever activity fits with the closure ceremony and allows the child to say good-bye in their own way.
• Getting a new pet
  This is a very personal choice. Children should not be rushed into getting another pet to help them "get over" the deceased pet. One pet does not replace another, and getting a new pet too soon may only cause the child to resent (even mistreat) the new pet. Only once the child can speak openly about the deceased pet and shows interest in a new pet should the subject of a new pet be discussed.

 

Livestock/Pet Insurance

Kenya has come of age. Many insurance companies are now willing to offer insurance packages for both livestock and pets. This is quite encouraging as the profession is getting attention as a stakeholder in the provision of professional advise.

Cruciate Ligament Rupture in a Boerboel Male

The Andys Veterinary Clinic Loresho Branch operated on a male boerboel who had a rupture of the left hindleg cranial cruciate ligament. The surgery went well and the dog is recuperating.