Stella is a beautiful tabby cat who presented to us at Hollybank veterinary centre because of lameness in her front left leg. Stella had become reluctant to go upstairs and jump on the sofa. She was showing abnormal behaviour whilst resting, such as suddenly jumping up and running away. Despite otherwise being fine she was just not herself and had become less interactive with her owners. Stella was already on a non-steroidal anti-inflammatory medication for previous complaints of lameness in her front legs. However, she was lame on her left leg despite still using these.

On examination, Stella was very reactive on extension and palpation around her left elbow. Given Stella’s age, gradual presentation and her level of lameness our suspicion was degenerative changes in the joint such as osteoarthritis. Osteoarthritis is a progressive condition and it is inevitable that with its progression animal’s will need additional pain relief and management.

For cats, this is where it can get complicated….

Most additional pain relief medications are in tablet form and some are known to be bitter; given that cats are notoriously good at spitting out and hiding tablets we often find ourselves limited with the pain relief that we can give, simply because we can’t get it in!

For Stella, we tried adding in additional pain relief tablets but despite her owners hard work and effort she was difficult to tablet. Next we opted to try a liquid version of the same drug, this was in fact a human drug and the flavourings added meant that Stella would not take this either! During this time, Stella’s lameness had got worse and she had begun to toilet inappropriately in the house, most likely as she was too painful to climb in and out of her litter tray.

Unfortunately, for many cat’s, treatment or management of a condition can be delayed or even not embarked on due to tableting difficulties. It is a major limiting factor and for some conditions there are no alternative options. However, for Stella we had another option. We elected to inject a long acting steroid injection directly into the joint space in her elbow. This provides a potent anti-inflammatory action at the source of the problem.

The procedure does require some sedation but at this point it was the next sensible step.Whilst sedated we took the opportunity to x-ray both elbows to confirm our suspected diagnosis. Both of the elbows showed degenerative changes and new bony formation, especially the left one.

Stella stayed in with us following the procedure for 24-hours of strict rest and made the most of lots of fuss from myself and our nurses. She went home the following day with a gradual return to normal activity. There was some risk that Stella might not respond to this therapy but within a few days Stella’s demeanour had improved, she was keen to go outside again and was using her litter tray! The improvement was brilliant and she seemed overall a much happier little cat.

Stella will remain on non-steroidal anti-inflammatories for the time being; in some cases we can stop these medications completely but it is not uncommon for animals to need these ongoing. Stella is also taking a joint supplement (yes a tablet she will eat!) The supplement will not reverse any of the changes already in the joint but will help to maintain a healthy joint environment and support the cartilage between her bones.

A few weeks on and Stella is still doing well. However, she has occasionally come home lame after spending time outside; it is really positive that Stella feels comfy enough to go and explore but because of this new found comfort she is likely to be over doing it on her expeditions. On further detective work by her owners she is climbing fences and jumping from heights!

Moderating our cats exercise is another limitation we face but completely restricting a normally outdoor cat indoors can often be more stressful to them. Our main aim after all is ensuring a good quality of life therefore we have to find a balance; as long as Stella is only occasionally lame after a big expedition and remains pain free and happy for the most part then we are happy too and we will continue to monitor her closely.

Please also see one of our older posts related to this subject

‘Arthritis in our feline friends’.

Meet Ernest! He is a wriggly miniature Schnauzer who spent quite a lot of time at Hollybank recently.

Ernest was noted by his owner to be straining to urinate over the Christmas bank holiday. A check-up and ultrasound scan showed there was no obstruction to his urinary tract and thankfully, Ernest recovered with a short course of treatment for inflammation of his bladder (cystitis).

Although cystitis is quite a common problem in female dogs, in male dogs there is often an underlying problem triggering the signs. To investigate further, a sample of Ernest’s urine was examined for abnormalities. Sure enough, there were lots of odd looking, spikey crystals seen under the microscope. Often the type of crystals we find can help us determine why they have formed in the first place. Ernest’s crystals were of a type called ammonium biurate which are sometimes found in Schnauzers without causing a problem. However, since Ernest had presented with urinary tract signs, we were keen to do a bit more detective work to work out why they had formed and what ought to be done about them.

Ammonium Biurate crystals

The formation of ammonium biurate cystals can be a symptom of abnormal liver function. This is because one of the liver’s jobs is to convert ammonia (a product of food metabolism) to urea. Normally, this urea is transported in the blood to the kidneys which excrete it into the urine. If the liver is not functioning normally, its ability to convert the ammonia is impaired. Ammonia can then build up in the blood to dangerous levels. In excessive quantities, it can form urinary crystals or even stones in the urinary tract.

Ernest’s blood test results confirmed the suspicion that his liver function was reduced. A good indicator of liver function is a bile acid measurement and Ernest’s reading was very high indeed; the pathologist at the external lab said it his was the highest she had ever recorded! Such a high level made us very suspicious Ernest could have an abnormal blood supply to his liver, this is called a portosystemic shunt. In patients with this condition, rather than blood being taken to and from the liver in the normal way, an abnormal blood vessel exists that diverts blood away from the liver. Since the liver is being bypassed, it cannot work on all the products of metabolism as it should. It also fails to develop to a normal size since it needs a good blood supply to its own tissue to do this. The overall result is that all the substances the liver ought to detoxify can build up to life threatening levels and cause a serious problem for the patient.

An ultrasound scan performed by Jerry Shimali, a visiting specialist, was arranged for Ernest and the presence of the portosystemic shunt was confirmed. The next step was to discuss treatment options with Ernest’s very worried mum. It can be tricky to decide on the best way forward in these cases. The only definitive treatment for any portosystemic shunt is surgery to occlude it and correct the blood supply to the liver. The trouble was that Ernest’s liver had been receiving a reduced blood supply his whole life and would not necessarily cope well with a sudden increase. Complications can range from abdominal pain to seizures and death. By this point, Ernest had recovered from his urinary signs. It is a big decision for any owner to weigh up the risks of surgery against a beloved pet that seems outwardly healthy. Ernest’s mum made the brave decision to go ahead with surgery on our advice that this would give him the best chance of leading a full and healthy life with the fewest long term complications.

Ernest took a month’s course of medications prior to his surgery to reduce his risk of post-operative complications. Finally, the day of his operation arrived; the tricky and delicate surgery was carried out by Catherine Sturgeon a visiting soft tissue surgeon with whom we work closely on a regular basis. Catherine took the utmost care to occlude the shunt at the optimum place in Ernest’s abdomen.

Thankfully, Ernest’s recovery from anaesthesia was uneventful. He was hospitalised at Hollybank for five days and was monitored very closely by our nurses during this time. A supply of emergency drugs was kept by his bedside in case they would be needed at any stage. The nurses worked hard at tempting Ernest to eat as soon as possible after surgery to keep his blood sugar levels up. Their meticulous care paid off and the little monkey was discharged, apparently unaware he had had a surgery at all! Over time, Ernest’s liver should become accustomed to its increased blood supply and take on more and more of a normal level of function.

Ernest returned to his owner as the same wriggly bundle of fun he has always been. We are delighted to report his wounds have healed and he is doing well without the medications. We look forward to hearing all about his future adventures with his sister Nora!