Harmony Animal Hospital's Blog

Let’s first start off with if your cat cannot urinate at all then stop reading and bring him/her to a veterinarian immediately or they will not make it. There is nothing that you can do to help him/her at home! These fur kids also cannot wait until morning or after work, etc. This is a life or death situation.

What is feline cystitis?
The term “cystitis” literally means inflammation of the urinary bladder. Although this term is rather general, there is a common form of cystitis that occurs in male and female cats. This disease is also known as Feline Urologic Syndrome (FUS) or Feline Lower Urinary Tract Disease (FLUTD). It affects the bladder (not the kidneys), resulting in the production of tiny crystals and urine which is bloody. The cat often urinates much more frequently than normal, usually with the passage of only a few drops of urine. This is often confused with constipation. Many cats will urinate in places other than the litter box, and often on hard surfaces such as tile floors, counter tops, sinks, and bathtubs. They should not be punished for doing so.

What causes feline cystitis?
We are not completely sure of the cause of this problem. Bacterial infections are the most common cause of cystitis in dogs and humans, but most cats with cystitis do not have bacteria in their urine. Neutering of male cats and feeding of dry cat food have been proposed as potential causes, but these have been disproved as initiating factors. It is true, however, that many dry foods may aggravate the problem after it begins. A herpes virus has been incriminated and someday may be proven to be the cause. Despite extensive research, the cause remains elusive.

Are bloody urine and straining to urinate the main problems?
Most cats with cystitis exhibit blood in the urine and discomfort in urinating. The discomfort is usually mild but can become much worse if it is not treated. Female cats may develop l/2 inch diameter stones in the bladder that must usually be surgically removed. Male cats may develop enough crystals in the urethra (the narrow tube carrying urine out of the body) to cause an obstruction. This is an emergency situation. This obstruction prevents elimination of urine from the bladder. If the obstruction is not relieved within several hours, most cats will die from kidney failure and the retention of toxins that were not removed by the kidneys. Because the urethra is relatively larger in the female cat, the emergency posed by complete obstruction is almost always found in male cats.

How is cystitis treated?
Each cat with cystitis is treated according to the changes in the urine (pH, crystals, blood, etc.), the type of crystals present, the presenting clinical signs (straining, increased frequency, etc.), and the presence or absence of a bladder stone or urethral obstruction.

If neither a bladder stone nor urethral obstruction is present, proper medication will generally relieve the discomfort. A urinalysis is necessary to determine the proper medication. A special diet, explained below, will help to dissolve crystals in the urine and hasten recovery.

If the cat has an obstruction of the urethra, a catheter is passed into the bladder while he is under a short-acting anesthetic. The catheter is frequently left in place for about 24 hours. The cat is discharged from the hospital when it appears unlikely that obstruction will reoccur, usually 1-2 days later. If he is experiencing kidney failure and toxemia, intravenous fluids and additional hospitalization are needed.

How long is treatment continued?
Following initial treatment, you will be asked to return the cat in 7-10 days for a recheck of the urine. This is very important because some cats will appear to feel much better, but the urine is still bloody or contains crystals. If medication is stopped based on how the cat appears to feel, treatment may terminated prematurely and a relapse will probably occur.

Can cystitis occur again?
Many cats have recurrence of cystitis. This is one reason that a virus is suspected as the cause. It is also the reason that a proper diet should be fed in the future.

Are there ways to prevent recurrence?
Two things should be done to help prevent recurrence.

• The most common type of crystals present in the urine are called struvite. These are dissolvable in acidic urine. Therefore, acidification of your cat’s urine can be a significant means of prevention. Several special foods are available for this purpose. However, if your cat’s crystals are not struvite, acidification may actually make recurrence more likely. Therefore, if at all possible, the crystals in the urine should be analyzed for their composition. This is the most important step in preventing future problems.
• Restrict the cat’s intake of dry cat food. Though dry foods do not cause cystitis, several studies have shown that the cat’s total fluid intake is decreased when dry diets are fed. When the fluid intake is decreased, the urine is more concentrated with minerals and other materials that can cause future episodes of cystitis. Canned foods can result in increased fluid intake and more dilute urine.

However, we know that many cats do not like canned food and that there are several distinct advantages to feeding dry food. Therefore, if there have been only a few infrequent episodes of cystitis, these other factors may be more important.

What complications may occur due to an obstructed urethra? The most common complication of a urethral obstruction is bladder atony. Atony means that the muscles of the bladder wall are unable to contract to push out urine. This occurs when they are stretched to an extreme degree. Not all cats with obstructions develop atony; in fact, most do not. However, if this occurs, longer hospitalization is necessary. The muscles will nearly always rebound and become functional again, but this may take several days to as long as a week.

Another complication that occurs occasionally is kidney damage. Although feline cystitis does not directly affect the kidneys, if the bladder becomes extremely enlarged, urine may backup into the kidneys and create enough pressure to temporarily or permanently damage them. If this occurs, prolonged hospitalization will be necessary to treat the kidney damage. However, with aggressive treatment, most cats will recover their normal kidney function.

It should be noted that both complications, bladder atony and kidney damage, are the direct result of the bladder becoming extremely enlarged. Both problems may be prevented by prompt recognition of the problem and prompt medical care.

My male cat has had several urethral obstructions. Can this be prevented?
Male cats that have more than one urethral obstruction can benefit from a surgical procedure called a perineal urethrostomy. The purpose of this is to remove the narrow part of the urethra that is the typical site of the obstruction. Although this prevents future obstructions, some of these cats will still have an occasional recurrence of cystitis, though usually not as severe.

This surgical procedure is also performed if the urethral obstruction is so severe that normal urine flow cannot be reestablished or if there are permanent strictures that develop in the urethra.

Surgically changing the cat’s urethra makes him more prone to bacterial infections in the bladder and bladder stones. Therefore, this surgery is only recommended if other means of prevention or treatment are not successful. However, the complications associated with the surgery are not life-threatening like urethral obstructions, so the surgery generally offers a significant benefit for the cat that really needs it.

Cat: “I have a problem eating my meals next to my litterbox. It’s gross!”

Note: No one wants to have dinner in the bathroom. Food bowls & water should be in a separate room from the litter box

Cat: “Wider dishes so that my sensitive whiskers don’t touch the edges would be awesome”

Note: the whiskers serve several functions and are highly sensitive. Thicker than the cat’s normal hair, the whiskers are really touch receptors that are rooted more deeply than normal hairs and are rich in nerve endings. The food dishes should be saucers or wide dishes. This will allow the cat’s whiskers to “be free” and not bump into the sides of the bowls.

Cat: “Give me only what I normally eat that day. I hate stale dry food”

Note: Only give the amount of dry kibble that your cat(s) will/should eat that day. Any leftovers should get thrown away and replaced with fresh kibble daily. If you simply top the dry food off the kibble on the bottom will go stale.

Cat: “Please replace my water daily. Would you like to drink an old, stagnant glass of water?”

Note: A domestic cat’s sense of smell is about fourteen times as strong as a human’s. Cats have twice as many receptors in the olfactory epithelium (i.e. smell-sensitive cells in their noses) as people do, meaning that cats have a more acute sense of smell than humans.

Cat: “Cats are picky about cleanliness and I’m no exception. I like my litter box cleaned at least once daily. My nose is very sensitive, as you now know. I would prefer if the litter was 2-3” deep as well so I can a little. And since I have a brother, we need our own litter boxes.

Note: Provide a box that is at least as long as the cat’s body and wide enough so that he or she can turn around easily. They must be cleaned DAILY. Check to see if the sides of the box are too high. This is particularly important for kittens and older cats that may have arthritis. Pour the litter approximately two to three inches deep for adults and one half to one inch deep for kittens. (Cats don’t like litter that’s too deep—a good sign that you’ve got the depth or texture right is if your cat scratches around in the litter.)  Use an unscented, clumping litter that is fine-grained. Find a litter the cat likes, and then don’t switch brands (cats don’t like change). Liners are useless. You cannot scoop out of a liner. The automatic litter boxes are very difficult to keep clean.  A nice deep Rubber Maid container is good. It helps keep the litter in the box. For a multi cat household the rule of thumb is to have one litter box per cat up to five cats.

Cat: “I’m losing my hourglass figure. Won’t you play with me?”

Note: Even if you don’t think that your cat seems bored, there are a number of good reasons to provide enrichment opportunities for your feline friend. Play is very important to cats – from kittenhood right through to old age. In fact, playing with your cat is one of the most enjoyable things about owning one. It also offers great health benefits, encouraging your cat to be active, keep supple and maintain a sleek body condition. More importantly, play can help to encourage cats to express their natural hunting instincts. Cats who lack enrichment can be aggressive in play, both with people and with other animals in the household. Young cats without planned enrichment opportunities often pester their pet parents for play at inappropriate hours of the day and night. They may also interact destructively with furniture, plants or other objects in the house. Cats lacking enrichment can become reclusive and are more likely to retreat from new people or objects that enter their homes than cats who are frequently exposed to a variety new sights and sounds.

Authored by: Simon Starkey BVSc, PhD, D.ABVP(Avian)

The adrenal gland is responsible for many important functions. One key function is to produce adrenaline (epinephrine). Adrenaline helps the body respond to life-threatening situations and is the key driver of the fight or flight response. The glands also produce a critical hormone known as cortisol. Cortisol assists in regulating blood sugar and in metabolizing protein, fat and carbohydrates; it is also an immune regulator. Finally, the adrenal gland also produces relatively small amounts of reproductive hormones and their precursors.

What is Adrenal Disease?

When used to describe disease in ferrets, adrenal disease refers to hyperadrenocorticism. This big term simply means an overactive adrenal gland. An overactive adrenal gland usually produces too much cortisol in humans and dogs, and this condition is known as Cushing’s disease (or syndrome).

Ferrets get a Different Type of Adrenal Disease

The type of adrenal disease that ferrets get is different to that seen in people and dogs. In ferrets it is the reproductive hormones that are overproduced with overactive adrenal glands. The glands may be overactive due to hypertrophy (exaggerated growth), benign tumors or a malignant form of cancer. Without a surgical biopsy or gland removal and pathology, determining which of the three causes of adrenal disease a ferret has is difficult to impossible.

What are the Clinical Signs (Symptoms) of Adrenal Disease in Ferrets?

The increased amounts of circulating reproductive hormones lead to one or more of the following clinical signs in ferrets:

• Hair loss: This usually starts at the tail and often extends to involve the back, stomach and ultimately most of the pet’s body. Some ferrets initially lose fur only over the crown of their heads and look a bit like little Friar Tucks. These pets may go on to lose fur over their entire body as well.
• Itching: Approximately 30% of ferrets with adrenal disease will have itchy skin. They may have little scabs and scratches from itching so much. Some ferrets will also show a yellow discoloration of the skin accompanied by waxy-type exuded matter.
• Swelling of vulva: The majority (over 70%) of female ferrets with adrenal disease will have an enlarged vulva secondary to the increased reproductive hormones produced by overactive adrenal glands.
• Anemia: Female ferrets may develop anemia. Typically it takes a veterinarian to diagnose anemia, however you may suspect it if your ferret’s gums appear pale or if she is weaker than usual.
• Aggression: Aggression and increased sexual activity can be seen in some ferrets with adrenal disease. Typically, aggression is more common in males, but can be seen in female ferrets as well.
• Urinary problems: Because of increased testosterone levels, male ferrets can suffer from an enlarged prostate that can make urination difficult or impossible. This rapidly becomes a life-threatening situation and warrants emergency veterinary care.

How is Adrenal Disease Diagnosed?

While the symptoms of adrenal disease in ferrets are fairly characteristic, it is important to allow your veterinarian to perform additional diagnostic tests to help confirm the diagnosis and determine your pet’s overall health. In any middle aged or older ferret, whether there are signs of illness or not, your veterinarian will likely suggest a complete blood count (CBC) and chemistry panel. These tests don’t diagnose specific diseases; however, they give an overall picture of health by assessing liver and kidney health as well as monitoring for anemia and signs of infection. There are two tests available to specifically diagnose adrenal disease itself:

• Ferret adrenal panel:  Your veterinarian sends a blood sample to the laboratory for endocrine testing. Three common reproductive hormones are studied and if one or more are elevated, and then a diagnosis of adrenal disease can be made.
• Abdominal or adrenal ultrasound: This test is done by a skilled veterinarian, often a specialist in radiology.  The abdominal (stomach) ultrasound is more comprehensive than an adrenal ultrasound as all abdominal organs are evaluated (liver, kidney, spleen, bowel, bladder, and prostate) in addition to the adrenal glands. In an adrenal ultrasound only the adrenal glands are evaluated. The adrenal-only ultrasound will likely be slightly less expensive than a full abdominal ultrasound, but may or may not be an option depending upon your veterinarian’s policies.

How is Adrenal Disease Treated?

Broadly speaking there are two main ways to treat ferret adrenal disease: medical or surgical management. The decision as to which to use is made between the veterinarian and the pet owner by considering the following factors: The ferret’s age and sex, the disease and symptoms, presence of additional diseases, affected gland(s) (left, right or both), owner’s desire for cure versus control, risks of surgery, possible complications during and after surgery, and willingness to tolerate possible recurrence or disease of opposite gland if surgery is performed.

• Surgery: Generally speaking the prognosis for left-sided adrenal gland removal is good and the chances of medium to long-term cure are good. Right-sided disease is complicated by the close proximity of the right adrenal gland to the largest vein in the body (the vena cava) and the liver. As such, right-sided or bilateral (both sides) adrenal disease carries a larger risk of complications as well as a reduced likelihood of cure. If the right gland is affected, the surgeon may only be able to partially remove the gland. This may slow the progress of the disease, but is unlikely to cure.
• Medical management: There are several types of medical management available. The medication offered to you will likely vary with your veterinarian’s experience and comfort level with one or more of the available treatment options. Medical management will help reduce and potentially eliminate some of the potentially life-threatening secondary symptoms of adrenal disease (such as anemia or urinary blockage) but it is generally not believed to be effective in slowing or stopping tumor growth in those ferrets affected by adrenal gland cancer.

Lupron (leuprolide): Lupron has been a mainstay of medical management for several years. This medication is generally effective in controlling clinical signs when given to ferrets by injection once a month. Lupron helps to reduce the hormone-induced aspects of adrenal disease, such as fur loss, estrogen-induced anemia and prostate disease. Lupron is essentially a synthetic hormone, and over time the ferret’s body may recognize this substance as foreign and create antibodies against it, thereby reducing its effectiveness.

Deslorelin: This drug is similar to Lupron, although it is available in a longer-term implant (8-12 months).

Melatonin: The use of oral melatonin has been studied in ferrets and it has proven effective in treating the clinical signs and hormonal changes seen with this disease. One problem with its use, however, is the lack of regulation of melatonin manufacture in the U.S. As such it can be difficult to be certain that the ferret is gaining the benefit it should from this drug. As an alternative, a melatonin implant is available to veterinarians in the U.S. This product is being actively researched and initial reports are very promising as to this product’s ability to improve fur loss and the hormonal status of ferrets with adrenal disease.

Treating adrenal disease requires a commitment on the owner’s behalf and teamwork between the owner and their veterinarian.