Help! Why is My Cat Peeing Outside of the Litterbox?

It can be frustrating for pet parents to deal with their cat peeing outside of the litterbox without knowing why it is happening. There may be an underlying behavioral or medical problem, and a visit to your veterinarian can help distinguish the two. Sometimes, treatment is easy and the issue resolves, but other times it can take some time and patience.

Feline Lower Urinary Tract Disease (FLUTD)

FLUTD is a term describing all of the urinary issues that can be attributed to a medical cause. Urinary tract infections, bladder stones, bladder inflammation, or urethral obstruction can all result in urinary issues. You may notice your cat urinating more frequently, passing blood in the urine, or straining to urinate. Your cat may even cry out when urinating or fail to pass urine at all! If you are noticing any of these signs, you should seek veterinary care.

Once at your veterinarian, he or she will do a thorough physical exam, collect a urine sample, and perform imaging, such as an x-ray or ultrasound. If these tests show that bacteria and inflammation are present within the bladder, your cat will be given anti-inflammatory and antibiotic medications followed by a urine recheck one week later. If the urinary tract infection is not resolving, it may be necessary to collect a sterile sample to better target antibiotic therapy. If bladder stones are seen, surgery may be necessary to remove them. Obstructions may be relieved by passing a urinary catheter or in severe cases, surgery may also be necessary. Cats with obstructions must be hospitalized for several days.

Once the underlying cause has been addressed and resolved, switching your cat to a diet formulated for urinary health and reducing stress in the environment may be recommended for long-term management.

Stress-Related Behaviors

Once all possible medical reasons have been ruled out, behavioral modification may be necessary. Cats can become easily stressed or anxious especially in multi-cat households where there may be conflict. Altering the environment through renovations or addition of a new baby can also cause stress to your cat, which can manifest as inappropriate urination. A few strategies can be helpful to try to eliminate these behaviors.

Feliway products, such as diffusers and spray, can be used. They emit calming pheromones which can reduce anxiety, fear, and stress in your cat. I also recommend having one more litterbox than the number of cats in your household. For example, if two cats live in your home, you should have three litterboxes each placed in a different area of the home. Providing vertical space, such as with shelving or cat trees is also helpful to keep cats active and engaged.

Inappropriate urination can be frustrating for pet parents. The first step in getting to the bottom of this behavior is to see your veterinarian who will be happy to discuss possible causes and treatment options.

What if I Don’t Get Into Veterinary School?

What if you don’t get into veterinary school on your first try? So what! Seriously, it may seem like the end of the world while the rest of your friends have the highly coveted letter of acceptance, but it really isn’t. There are only 30 accredited veterinary schools in the United States with on average 100-130 students per class. With so many more applicants than seats available, it is not uncommon for aspiring veterinarians to go through one, two, even three application cycles before getting in.

I know it is easier for me to say than for you to see the bigger picture now, but rejection can lead to blessings in disguise. I am a firm believer that everything happens for a specific reason and that sometimes it takes a little searching and trust to determine exactly what that reason is.

During your “off year,” you can grow as a person, explore fun opportunities, and gain more experience to strengthen your application. Maybe you will discover something new about yourself or your interests that you will be able to build upon for the next application cycle.

One piece of advice I would suggest is to reach out to the schools that you applied to and ask how you may increase your likelihood of gaining acceptance next cycle. Usually they will be able to provide feedback on the application components or your interview. Sometimes experience is lacking, which is fairly easy to correct by shadowing more or getting a job at a vet practice during your year off. Sometimes the interview does not go as planned and you can take advantage of the career center and mock interviews at your undergrad for additional practice. If you performed poorly in a course, you can retake it to increase your GPA. It is great to show initiative so don’t be shy reaching out to schools and don’t take the critiques too personally. Have confidence and work hard during your year off, and I bet you will be holding an acceptance letter next time around. Good luck!

Encouragement for DVMs

It’s the usual summer busy season in veterinary hospitals. On top of that, we are still in the season of COVID-19, so add those together and you get complete chaos on some days! As a newer grad, I am still learning the ins and outs of daily life in practice. I have found more confidence as the weeks progress, but I still wake up some days with anxiety about what the day may bring and if I will be good enough for my patients. I am hoping with more experience those feelings will subside, but in the mean time I believe I am growing as a person and as a doctor.

I recently had a fully booked day of appointments with several patients needing diagnostics and treatments done. In addition, we had about twelve drop-offs added to the schedule that morning. Needless to say, I was quite busy, and at one point I was managing six hospitalized cases- a diabetic dog getting a glucose curve, a dog with hemorrhagic gastroenteritis, a dog with pancreatitis, a blocked cat, a dog with chronic kidney disease, and a dog with a brachial plexus avulsion. That is quite the variety! It was one of those days I couldn’t wait to be over so I could breathe.

The demands of daily practice, especially during this time, can be overwhelming. We are a profession of compassionate caregivers. We push ourselves and replay cases over in our heads wondering if we made the right choices. We strive to be perfect and get discouraged when we can’t possibly live up to that standard. That is too heavy a load to carry even for the most seasoned veterinarians! Trust me, I need to remind myself of this daily.

It’s okay to not be perfect. It’s okay to make mistakes and then learn from them. It’s okay to ask for guidance, and it’s okay to give yourself grace because we are only human and can only do so much. At the end of the day, what matters is that we’ve done our best to advocate for our patients. All we can do is our best, and that is enough.

Tips for Keeping Your Dog’s Teeth Clean

Periodontal disease affects many dogs that do not receive appropriate preventative dental care. It is divided into four stages depending on the severity of disease. Minerals within your dog’s saliva become stuck to his or her teeth and harden to form dental calculus. This causes inflammation of the gums, which can weaken the periodontal ligament that holds each tooth in place. Bacteria can then gain entry to the tooth roots, resulting in loose teeth and root decay. This can become painful for your dog, especially during meal time. A foul smell permeating from your dog’s mouth can also provide a clue that something is amiss.

If you suspect there may be an issue within your dog’s mouth, a visit to your veterinarian is recommended. If there is only mild dental calculus present, at-home dental care may be started to prevent progression of disease.

Here are some helpful tips to ensure your dog’s teeth stay fresh and clean.

  1. Brush their teeth! In most dogs, tooth brushing is actually quite simple. Enzymatic toothpaste specifically designed for dogs is available online or at pet stores. Brushing once daily before bedtime can remove food and plaque from their teeth so that it doesn’t calcify overnight.
  2. Use a dental rinse. This involves simply squirting some rinse into both cheeks so that it contacts the teeth. These rinses typically contain chlorhexidine as an ingredient which reduces bacteria that can lead to gum disease. Although less effective than brushing, it is a good option in some dogs.
  3. Give them a dental chew. Rawhides or Greenies are great for scraping the plaque off of teeth as your dog chews them. Just be diligent about supervising your dog so that a large piece is not swallowed which could be a choking hazard or cause an intestinal blockage.
  4. Feed a large, dry kibble. There are specific diets formulated to reduce plaque buildup on teeth, but feeding any dry kibble is beneficial. The large pieces scrape against teeth as your dog chews, which can remove any unwanted plaque before it calcifies.
  5. Get a professional cleaning. Some veterinary hospitals offer dental radiographs (x-rays) where the doctor can get a good look at what may be happening beneath the roots. A close visual examination is also performed while your dog is under anesthesia which can detect early gum disease and diseased teeth. These teeth can be extracted, and scaling can be performed to remove built-up calculus. The results of a professional cleaning are pretty amazing!

Dental disease is something that often goes unnoticed by pet parents until it progresses to a severe state. By implementing these simple steps, you can ensure your dog’s mouth stays as healthy as it can be!

Wait…my dog has fleas?!

Summer is upon us, and that means more pets are arriving to the animal hospital with allergies and corresponding clinical signs.  Oftentimes, their itchy skin and hair loss is related to fleas. These small parasites are frequently found outdoors and can jump on your dog while he or she is sunbathing, taking a walk, or playing ball. An allergic reaction to the saliva can occur in sensitive dogs when a flea bites, leading to intense itching, hair loss, and inflamed skin. This can be incredibly uncomfortable!

If your dog is experiencing itchy skin or losing hair, it is best to see a veterinarian for a thorough physical exam. A flea comb will be used to identify any live fleas or flea dirt (feces of fleas). The most common distribution of hair loss and inflamed skin secondary to flea allergies is on the rear end near the tail base and down the hind legs.  Absence of fleas or flea dirt does not necessarily rule out flea allergy dermatitis. When your dog goes outside, a flea can still jump on, bite, and trigger a reaction. However, the flea will not stick around and cause additional issues if your dog is current on monthly prevention.

Flea prevention is essential year-round to prevent infestations and these secondary signs in your dog. Products that work to kill fleas and ticks rather than repel them are preferred. A couple products in this category include Bravecto or Credelio. In addition, using a household cleaner specifically formulated for fleas will help eliminate any infestation present within your dog’s home environment that can wreak havoc. This is an essential step in resolving the issue. Be sure any other pets in your household are also up to date on flea prevention! Fleas can be difficult to treat due to their extended life cycle. However, this is a treatable condition with a good prognosis. For dogs that are particularly itchy, anti-histamines or steroids can be given to provide relief while any fleas are being eliminated.

Atopic Dermatitis in Dogs

I have been seeing numerous patients suffering from allergies recently. Environmental allergies are seasonal and occur most commonly in the spring and summer when there is an abundance of pollen and other allergens. This condition is medically referred to as atopic dermatitis.  

First, it is important to differentiate atopic dermatitis from food or flea allergies. To learn more about these other allergies, you may read my previous blog post. Atopic dermatitis usually affects a dog’s belly, paws, muzzle, or ears. Dogs suffering from this condition are usually brought to the animal hospital because they have started to itch, lose hair, or chew their paws. Additional presenting complaints may include watery eyes, sneezing episodes, or malodorous skin. Common environmental allergens are pollen, dust, molds, hay, and grass, among others.

There are specific tests available through your veterinarian to pinpoint the exact allergens your dog is sensitive to. One test is serological and consists of submitting a blood sample to detect antibodies against more than a dozen potential allergens. Intradermal skin testing is also an option, which consists of injecting a small volume of allergen within the skin and assessing whether any swelling or redness results.

Many treatment options are available to provide your dog relief from allergies. In dogs that are only mildly affected, antihistamines or medicated shampoos may be effective. Diphenhydramine (Benadryl), hydroxyzine, and cetirizine (Zyrtec) are all commonly prescribed antihistamines but be sure to get veterinary guidance before administering anything to your dog. These medications reduce the histamine response that occurs from allergies but must be administered frequently to maintain their effect. Medicated shampoos can have anti-inflammatory, anti-pruritic, and antimicrobial properties. Often, they are used in combination with another therapy.

Steroid injections can provide immediate relief from itchy skin and inflammation. The relief is usually short-lived and lasts about two weeks. Steroid injections should not be given repeatedly because they have a wide array of side effects. However, they can provide relief while you determine a long-term treatment strategy.

Two medications–Apoquel and Cytopoint— have been specifically formulated to combat allergies. Cytopoint is a subcutaneous injection that starts working within 24 hours and lasts 4-8 weeks. It is very safe and works to block a specific inflammatory cytokine involved in the itch pathway. Apoquel is an oral medication that also targets the itch pathway and begins working within 4 hours. Monitoring bloodwork with long-term use of Apoquel is recommended.

In severely affected dogs, immunotherapy injections may be recommended. They can provide long-term relief since they slowly build up tolerance to specific allergens. This therapy consists of a series of subcutaneous injections that each contain increased doses of the allergen. Injections are continued until an adequate dose is given to provide immunotolerance. This means your dog’s immune system will no longer react to the allergen causing issues. The goal of this therapy is similar to that of vaccines, which primes the immune system against certain disease.

The prognosis for dogs affected by allergies is good, but it can require lifelong treatment to reduce clinical signs and ensure your dog is comfortable.

Help! My dog won’t stop scratching his ears.

One of the most common reasons for a dog’s visit to the veterinary hospital is ear issues. Pet parents notice their dogs will not stop scratching their ears or that there is a foul smell permeating from them. So what exactly does this mean? Dogs, especially those with floppy ears, commonly get ear infections that cause pain and irritation. If you suspect your dog has an ear infection, a visit to the veterinarian is warranted.

Your veterinarian will perform a thorough ear examination using an otoscope. This device is used to look deep down into the ear canal to visualize the ear drum and the internal ear canal. A dog’s ear canal is “L-shaped,” which means that when you flip your dog’s ear up and see the canal, you are only seeing half of it. Debris can get stuck deep down in the internal ear canal which can provide the perfect dark, moist environment for bacteria to harbor and cause infection.

After examination, your veterinarian will collect a sample of the ear debris using a cotton swab. Then, that sample will be pressed onto a glass slide, stained, and examined under a microscope. Yeast and bacteria can be identified and quantified using this method. There should be rare to no bacteria and yeast present within your dog’s ears normally. If there is an abnormal amount of these organisms present in the sample, an ear infection is diagnosed and treatment is discussed.

Treatment consists of topical antimicrobial medications instilled within the ear. Ear cleaners are often provided to use at home to remove excess debris as well. Typically treatment is required for 7-10 days followed by a recheck to ensure the infection has fully resolved before medication is discontinued.

Uncomplicated ear infections are usually very easy to treat, but if the infection becomes persistent, it can penetrate the inner ear and cause complications. If you suspect your dog may have an ear infection, it is best to schedule a veterinary visit sooner rather than later.

Understanding Canine Hypothyroidism

Hypothyroidism in dogs occurs when there are decreased levels of thyroid hormones present within the body. It is common in middle-aged to older dogs. These hormones are important for maintaining heart rate, a healthy hair coat, energy levels, ideal body condition, and normal body temperature.  

What causes it?

The pituitary gland secretes thyroid stimulating hormone (TSH) which stimulates the thyroid gland to produce T3 and T4 (thyroid hormones). When there is a problem along this pathway, low levels of thyroid hormone can occur. The most common cause of hypothyroidism is lymphocytic thyroiditis, which means that the immune system is attacking the thyroid gland and causing inflammation and destruction. Atrophy of the thyroid gland may also occur as dogs age. A tumor within the pituitary gland that prevents TSH from being produced is another possible cause, but it is much less common than primary thyroid disease.

What are the clinical signs?

Since thyroid hormones are important for metabolism, dogs typically experience weight gain despite a normal diet. Hypothyroid dogs will often have fat accumulating along their hind ends, shoulders, or neck regions. Low heart rate, lethargy, and abnormal hair coat (shedding, hairless areas, dandruff, thickened skin) are often found. Hypothyroid dogs also cannot regulate their body temperature as efficiently and are often heat-seekers.

How is it diagnosed?

Often, this disease is detected through annual wellness bloodwork when T4 levels are checked. If results indicate a low T4, hypothyroidism should be considered. However, many non-thyroidal illnesses can cause low T4 levels so it is important to decipher these based on clinical signs and additional testing. In dogs where hypothyroidism is suspected due to a low T4, a comprehensive thyroid panel is submitted. If the values in this panel match what we would expect to see in a hypothyroid dog, your veterinarian can make the diagnosis. High cholesterol and high triglyceride levels are often found on bloodwork as well.

What is the treatment?

Treatment consists of supplementation of thyroxine (T4). This is a relatively inexpensive medication that is given orally every day. Hypothyroid dogs must be regularly monitored while receiving this medication to ensure the dosing is appropriate to maintain normal thyroid hormone levels.

What is the prognosis?

The prognosis is generally good for dogs receiving supplementation. As long as regular monitoring is performed via bloodwork and veterinary visits, most dogs can go on to live normal lives.  

Cat Vaccines

There are far fewer vaccines available to cats compared to dogs. We will discuss three of the most common vaccines given. Two of these are considered core vaccines, and the other one is specifically for at-risk cats.

Core Vaccines

Rabies
The rabies vaccine is given to kittens between 12-16 weeks of age. The first vaccine is good for one year, and each booster is good for either one or three years thereafter depending on the label. This disease is the same in cats as we see in dogs. It is transmitted through the saliva of an affected animal and results in severe neurological disease leading to death.

FVRCP
This vaccine protects against three diseases, which include Feline Viral Rhinotracheitis (herpes), Calicivirus, and Panleukopenia (feline distemper). The first dose is given between 6-9 weeks of age followed by boosters every 3 weeks until 16 weeks of age. It is boostered again at one year and then every 3 years thereafter. Feline herpes and calicivirus both cause upper respiratory disease and eye or oral lesions. Feline panleukopenia is a severe, but very uncommon disease in cats today. It causes gastrointestinal and neurological disease.

Non-Core Vaccines

FeLV
The FeLV vaccine is the most common non-core vaccine we consider for cats. It can be given to kittens or adults, but it must be boostered 3 weeks after. It is only given to cats who are outdoors and considered high risk. Cats should test negative for FeLV prior to receiving their first vaccination because if they test positive, there is no need for the vaccine. Read more about FeLV in cats here!

In the past there had been controversy regarding vaccines in cats due to the added adjuvant that was used to boost the immune response. Select cats developed injection site sarcomas (masses) from these vaccines. Now, vaccines have been developed that do not contain these adjuvants and are less controversial in veterinary medicine today. Your veterinarian will be happy to go over what vaccines he or she uses and any concerns you have at your cat’s first appointment.

Dog Vaccines

Vaccines are administered to prevent specific diseases throughout your dog’s life. Core and non-core vaccines are important to ensure your dog stays protected and healthy!

Core Vaccines

Rabies
Rabies is a zoonotic viral disease that is transmitted through the saliva of infected dogs, specifically when they bite. It causes severe neurological dysfunction and death. It is important that your dog stays up to date on this vaccine to protect him or her. If a dog is not kept up to date on the rabies vaccine and is exposed, he or she may need to be euthanized or undergo strict quarantine for a period of time to ensure the disease was not contracted while susceptible. The rabies vaccine is given to puppies between 12-16 weeks of age. The first vaccine is good for one year.  Every booster after that is good for 3 years.

Distemper (DAPP)
Canine distemper is also a viral disease that causes gastrointestinal, neurological, and respiratory signs. It is spread through bodily fluids, and young, unvaccinated puppies are most susceptible. The distemper vaccine is given between 6-9 weeks of age and boostered every 3 weeks until your dog is 16 weeks of age. We vaccinate so frequently because maternal antibodies are still present in young puppies and can interfere with their immune responses to vaccines. By 16 weeks of age, all the maternal antibodies should have disappeared, and your puppy will have mounted a sufficient immune response to be protected. The distemper vaccine is administered again at one year of age and then every 3 years.

Non-Core Vaccines

Bordetella
Bordetella is a type of bacterium that can cause infectious tracheobronchitis (kennel cough) in dogs that come in contact with each other, such as during grooming, daycare, or boarding. As the name describes, this disease results in upper respiratory signs. It is administered in dogs 10 weeks and older. The first dose is given intranasally for a localized immune response, and boosters are given either intranasally or subcutaneously thereafter. Boosters are done every 6 months-1 year depending on your dog’s exposure level and your veterinarian’s preference.

Leptospirosis
Leptospirosis is a type of spirochete bacterium that is transmitted through contact with infected wildlife urine or puddles. It is zoonotic and most commonly causes kidney and liver disease. This vaccine can be combined with the second distemper vaccine booster or given individually. It is boostered 3-4 weeks after the initial dose and then yearly. It is only given to at-risk dogs.

Lyme
Lyme disease is caused by a bacterium known as Borrelia burgdorferi. It is transmitted by tick bites and causes kidney and joint disease. This vaccine is administered at 12 weeks of age with a booster 3-4 weeks later. It is then given yearly to at-risk dogs.

Influenza
There are currently two strains of influenza seen in dogs. Influenza causes upper respiratory signs similar to what we see in people. It is highly contagious among dogs coming in close contact with one another. The vaccine can be administered at 8 weeks of age and then is boostered 3-4 weeks later. It is then given yearly to at-risk dogs.