Feline Inappropriate Urination – Part II: Please Make It Stop

        Once we've considered who is peeing in the heater vents and we have asked ourselves why they are doing it, we can  tackle the what, where, and how of  solving the problem.  Treatment has to be individualized to each situation and cat, or cats.  Of course, we may not discover the  exact reason for the inappropriate urination  so a multimodal approach is best in most cases.   

1.      The soiled environment.  The urine-soiled area needs to be thoroughly cleaned with an enzymatic cleaner, such as Nature’s Miracle, to  eliminate future visits.  The area also may need to be closed off from the offending cat.  Plastic totes, double sided tape, foil, furniture placement, potted plants, and invisible fencing may all be  used to prevent access.  If the specific area is not easily identified, a black light can help locate soiled spots.

2.      The litter box.  Make sure the box is roomy and comfy for everyone who needs it.  Obese cats and large cats need more space.  As a rule, sides, liners and covers are bad.  Kittens, older cats and the infirm may have a hard time negotiating sides on the box.  Liners are just annoying when kitty   tries to scratch around and cover feces and urine.  Box covers trap smells and block kitty’s view of intruding other cats.  As a cat, one typically likes a 360-degree view while eliminating.

3.      The box placement and number of boxes.  As stated before, one box per cat, plus one, is recommended; and make sure that there is a box on each level of the house.  Put the boxes in well lit, quiet areas away from food and water but close to where the cats spend the majority of their time.

4.      Pick the right litter.  Most cats prefer fine-textured, unscented litter, several inches deep.  If in doubt, try litter box samplers.  Put out several different boxes with several different types of litter - clay, sand, paper litter, or even soil.  Let your cat cast its vote with urine and go with the demonstrated preference. 

5.      Cleanliness.  As a basic rule of thumb, scoop the box daily.  This may not be enough in multi-cat households if one box is particularly popular.  If you ask the cats, they would each want a personal litter box valet that kept the other cats out of the area, looked away while they used the box, handed them a kitty treat as they exited the box, and then removed any offending material immediately.  Always empty and thoroughly clean boxes every 1-2 weeks, depending on use.

6.      Avoid punishment.  Never physically punish your cat for inappropriate elimination.  Not only  is that ineffective, but it quite likely will make things worse.  Punishment will create more anxiety and cats will not connect the crime to the punishment.

7.      Medical treatment.  If your veterinarian uncovers medical issues such as drinking more water or urinary tract infection, treatment plans will need to be determined and implemented.

8.      Anxiety and urine spraying.  Anti-anxiety medications may be utilized.  Drugs such as Prozac, amitryptylline, and busprinone can be  prescribed.  Medication use would need to be discussed with your cat’s doctor.  Such therapy is often life-long, although withdrawal of medication may be considered after long periods of good behavior.  We may also use pheromone sprays, such as Feliway, to promote positive feelings in the cats when they enter the area involved.

        Feline inappropriate elimination is a frustratingly common problem.  It is imperative to act quickly when it happens.  The longer such a problem goes on, the more difficult it may be to correct.  Once the offending cat is identified, take him or her to your veterinarian for a thorough physical examination and have a discussion about your options.  Once medical disease is ruled out, together we may tackle the many issues discussed here and formulate our best plan.  With thought, perseverance, environmental manipulation and appropriate medications, we can  often help.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)
Outreach Chairman, American Board of VeterinaryPractitioners

Help! Why is My Cat Urinating Inappropriately Everywhere?

        First let’s set the record straight.  Your cat does not view its urinary habits as inappropriate, regardless of where the cat happens to pee.  Feline house soiling in the form of urine placed outside the litter box and urine marking are normal feline behaviors.  It is us, the cat owners and feline lovers, who find random urine placement objectionable.  Second, it is no joking matter.  Inappropriate urination is a very common reason cats are relinquished to shelters.  These cats often are not suitable for placement in a new home and many are euthanized.             
         If veterinarians and veterinary staff can help someone understand and solve this problem, they can improve cat owner's lives and may even keep cats out of shelters.
         In multi-cat households, we will need to identify the guilty party or parties.  It is not uncommon that multiple cats may be involved in this outside-the-box activity.  
         For cats that are intact, we need to consider having them spayed or neutered.
         As an important aside, cats never inappropriately urinate out of vindictiveness to their owners.  

Once we know who, then we may consider the myriad reasons a cat may decide that a litter box is not their preferred place to urinate:
1.       Size.  The litter box may be too small
2.       Substrate aversion.  They don’t like the material that is in the box for litter.  Some cats like dirt, or clay, or sand.
3.       Location, location, location.  Perhaps something scary happened where the litter box is and they don’t want to go back.  Maybe it smells funny to them.  Maybe the location next to a loud furnace is a deterrent.
4.       Cleanliness.  They don’t think the cat box is clean enough.  Typically, the litter box needs to be emptied daily to keep cats happy.
5.       Remoteness/distance.  Maybe it is too far to get to the box on time.  Basically, each level of a house needs a litter pan, even if you just have one cat.  This idea is especially important in older cats or any cat with mobility issues.
6.       Bullying.  This is very common.  One cat may prevent another from getting to the potty.  A household needs enough boxes to help defuse bullying.  The rule of thumb is  one litter box per cat, plus one.  For example, a three-cat household needs four boxes.  It doesn't matter whether you want four boxes; the cats want four boxes.  And the boxes don’t count if they are located next to each other.  The idea is that the cat that is being a bully can’t possibly patrol all those boxes.  There needs to be physical separation between the boxes.
7.       Anxiety.  In my experience, this is the most common problem.  Other problems like bullying can contribute to this, but separation from the owner is also a common form of anxiety.  If identified correctly, anxiety issues may respond to medication.
8.       Urine marking/spraying.  This is normal communication in the cat world.   This form of urination usually occurs on vertical surfaces and usually the cat will urinate in its cat box as well. Cats may spray when they are threatened or perceive a threat to their territory.  New cats in the house and cats outside may be a trigger for this behavior.  New things like carpet and furniture or moving to a new home also may be triggers.  Cats also may spray out of frustration.  Circumstances  such as enforced diet change and lack of time with their owner may trigger spraying behavior.  
9.       Medical issues.  This needs to be ruled out by our veterinarian.  A thorough exam and a urinalysis will help identify problems and possibly provide a solution.

If you have a feline friend with urinary issues, let us know.  We would be happy to help.

Next week:  solutions and options.


Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Walking the Relay For Life

        This last weekend we participated in Relay for Life at the Vashon Island high school track.  The American Cancer Society sponsors overnight relay walks in communities all over the world to support cancer survivors and their caregivers and to raise money for cancer research.  We had a combined team of clinic staff and our daughter Aubrey's friends.  The relay has someone from each team actively walking at all times from 6:00 PM one night to 9:00 AM the next morning.  Many months ago when Aubrey proposed this walk, it seemed like a good idea.  Aubrey was on the organizing committee for the walk and that made it difficult to decline.  Later, while I was planning the camping needs and logistics with Dr. Fritzler, it seemed very far from a good idea.  Sitting here the next day, it was fun and moving and was well worth the time and effort.

We set up a schedule to have at least two of us walking at all times.  I spent the most of earlier Friday getting the gear ready, preparing the tents and setting up camp for us.  The night started with recognition of survivors and their caregivers and then the teams started to walk.  My son Nick and I took the first hour in the stifling heat with the sun blazing on us, especially whenever we rounded the track and headed west.  Dr. Fritzler had packed a cooler with sandwiches and drinks and snacks were everywhere.  I had set up a two tent compound so people not walking could sleep.  Nick and I were the only guys, so a separate tent for us and Dr. Fritzler seemed prudent to avoid any awkward cuddling incidents through the night with staff and Aubrey's friends.

          As night fell, small bags with lights were put all around the track.  There was a “luminaria” booth that was making the bags throughout the earlier evening.  I hadn’t really understood what it was.  But then the bags were all lit around the track when it was dark and we walked around them.  Each bag had a message to someone that had succumbed to cancer.  It was very sobering and sad and unifying.  So many people are lost to cancer.  Everyone has a story.  There were notes to aunts and uncles, moms and sons, friends, dads, daughters and grandparents.  I wished I had figured out what the booth was before.  My favorite uncle died of lymphoma when I was 16.  He was only 40. 

          Later, Aubrey broke out an endless amount of glowing bling and we were all covered in glow stick necklaces and bracelets.  Joon, Hilari’s 4 year old daughter, could be seen by satellite.  Dr. Fritzler and I took the 11:00- midnight shift and then slept for several hours.  Kas walked on and did over 14 miles total.  She and I did the 4:00-5:00am shift together with my brother.  Johana came a bit after it started and walked with Aubrey and Kas well into the night.

          Morning broke to the teams all still continuing around the track and the music still blaring.  Oddly tasty
pastries with chicken were served for breakfast and a torrential downpour hit as the walk concluded.

          It was a good night. 

Last month we had a management retreat to consider our clinic mission, core values, and goals.  Dr. Fritzler, myself, Johana, our practice manager, Sarah, our head technician, Kas, our head receptionist, and Andrea, our operations manager all met for a weekend.  We spent time considering where the clinic goes from here and what are our values as a group.  One of our core values we talked about is to be involved in the global community.  The relay was a small start and part of pursuing that goal.

We will be back next year and hopefully for many to come.  Next time I’ll put out a light and note for my uncle.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Man and Man's Best Friend - Remembering Jeff and Partner

            Partner died a number of years ago.  If you asked me when, I would have said it was a few years ago.  I looked it up; he died in 2004.  It seems like I was just in an exam room with him.  I think of Partner often.  He was one of the good dogs.  I see many wonderful patients and wonderful owners and Partner was one of the former.  His dad, Jeff, was one of the latter.  I took care of Partner for the majority of his life.  He was a big German Shepherd that was both serious and silly.  He never enjoyed coming to the vet as much as we enjoyed seeing him.

            We saw Partner a lot during the later three quarters of his life that we knew him.  He was prone to skin infections and allergies.  His skin maladies are common to Shepherds and he took frequent antibiotics to control Staph infections in his skin.  He was also very arthritic in his later years.  We saw him often for Adequan injections for his joints and he took medication for arthritis and pain.  All of this meant that Jeff and Partner knew their veterinarian well.

            Jeff’s daughter called the other day to let me know that Jeff had died.  Jeff was an older man when I met him 17 years ago so I know he had a long life.  To his vet, it certainly seemed to be a happy life as well.  When I met Jeff in the 1990’s, I noticed his address was familiar.  His house was 5 houses from the one I grew up in.  I had been the paper boy for our block when I was a kid.  I remember riding by his house on my bike.  He, however, didn't subscribe to the paper.  I did, eventually, try to forgive him for the slight.  Jeff and I used to talk about “the hood” all the time.   He would tell me the latest.  I would ask about the cast of characters from my time there.  We would reminisce about the old lady that still had her picture window boarded across with plywood and the people that had moved away.  He was bright and funny and had a joyful way about him.  He and Partner were indeed partners in life.  They had one of those special bonds that are a pleasure to watch and fulfilling to experience.  They are what makes veterinary medicine the grand profession it is and the two of them were the type of creatures that motivated James Herriot to put pen to paper. 

I had seen Jeff many times in the years since he lost Partner.  He also had a cat.  It was never as often but when he was in we spoke frequently of Partner.  I think he was the one Jeff never really got over.  I saw Jeff’s own deterioration over the years and watched his memory lapse.  In recent years, his daughter would bring him to the clinic.          

          So long guys.  I said goodbye to Partner years ago but now it is goodbye to Jeff as well.  I trust you are walking together again.  I’m sure Partner's skin is healed and his hips move freely.  I trust also that Jeff is no longer forgetful nor lonely for his friend.  Thanks for stepping into my exam room.  The planet is a better place because you walked on it.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

The Controversial Non-Anesthetic Dental Cleaning

Dental care is a complex issue in veterinary medicine.  Perfect dental care for pets is rare.  Complete homecare can be difficult and more extensive dental care has traditionally always required anesthesia. We provide non-anesthetic dental procedures and we believe these cleanings are an invaluable part of a complete dental program.  At our hospital, non-anesthetic dental cleanings are performed by technicians from Animal Dental Care. They are a company of highly trained veterinary dental technicians that come to our practice.

The non-anesthetic dental (NAD) is an oral assessment and charting, teeth cleaning and polishing done with gentle restraint.  The NAD should be used only with patients that have minimal, early (stage 1) dental disease who are easy to handle.  Because the patient is not asleep, it is not possible to mirror all that can be done in an anesthetic dental procedure.  Deeper disease may be missed in non anesthetic procedures.  Behavior issues and patient compliance can interfere.  Dental radiographs, extractions, and some level of assessment simply is not possible awake.  The NAD and the anesthetic dental should be considered as two distinct procedures.  You and your veterinarian need to determine, often along with the trained dental technician, if a NAD is appropriate.  As noted, we have to consider how much dental disease is present and your pet’s temperament.  During preventive cleanings, Animal Dental Care technicians also may find disease that requires further care under anesthesia.

“Dental” procedures are also often done at pet shops and groomers without anesthesia and without the supervision of a veterinarian.  This easily may lead to pets with too high a degree of dental disease receiving incomplete and inappropriate dental care.  There is no benefit to simple removal of the tartar if deeper issues are present.     

Non-anesthetic dentistry is a controversial topic in veterinary medicine.  There are those that believe dental procedures should never be performed without anesthesia.  They believe that it is not possible to accomplish significant dental cleaning and assessment awake.  We disagree with this.  The technicians with Animal Dental Care have demonstrated over many years and hundreds of patients that they can effectively treat early dental disease.  As long as we select the right patients, good can be done with the NAD.  The best times for us to recommend a non-anesthetic procedure are early in life when there is minimal tartar and in between anesthetic dental cleanings when the tartar build up is low.

We believe providing non-anesthetic dentistry for the right patients in the right circumstances is the best dental care for our patients.  Feel free ask us for more information.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Summer Baseball

My first writings were about family and veterinary medicine.  The next most important topic is baseball.  This is because baseball is the perfect game.  The preceding statement is something I no more need to defend than one would need to explain their religious leanings or their belief that their mother makes the best chocolate chip cookies.
              This Saturday was a baseball marathon.  It was all baseball, all day.  Nick, my twelve-year-old, was playing in a tournament.  I spent the day in a comfy fold-up chair with a friend watching our boys play and elusively chasing shade.  We chatted crossword puzzles and baseball.  After the last game, he and I took our boys to the Mariners game.  

The boys played two games in the grueling heat.  I’m from Seattle so “grueling” is anything above 75 degrees.  Though, to be fair, it was 90+ degrees on Saturday.  You could have fried an egg on the pitcher's mound.  Their first game had several good innings but the defense was colander-like and the other team hit too many balls hard.  They lost by a lot.  The second game was worse.  There were moments though.  My son caught two outfield fly balls.  The catcher played well and hit a double.  The pitchers threw strikes and bravely carried on.  They lost by more.  Even from the losing side of the diamond, a day watching baseball is a good day.  We scurried out quickly and headed to Safeco.  Iwakuma was slated to pitch.

We sat in seats close to the field that my family has had since the first season the Mariners played.  I grew up, and my kids have grown-up, in seats behind the plate.  We watch pitches break and hitters buckle to curve balls.  We call pitches with the umpires and question their strike zones.  We watched Ichiro do his on deck routine for many years.  We saw Felix Hernandez break in to the majors and learn to dance his pitches around the strike zone.  I saw Ken Griffey Junior explode on to the scene and I watched Randy Johnson learn to throw “Mr. Snappy”.  I was there for every game of the 1995 division series when Edgar Martinez took out the Yankees and Seattle became a baseball town.  And it is a baseball town.  We may mock the Mariners in their drought of prominence but it is different now.  The discussion goes on today, win or lose.  Pre-1995 was another era.  The Mariners were irrelevant except to the faithful.  The Kingdome echoed.  We could hear the pitchers grunt and the ball hit the catcher's mitt.
              Iwakuma was masterful Saturday.  Kyle Seager and Robinson Cano hit homers.  The team played stellar defense.  The Mariners won and took the second game in a row from Oakland, the best team in baseball at the moment.  It is July and the Mariners are in the conversation.  If the playoffs were tomorrow, they would be the second wild card team.  I spent the game talking baseball with my friend.  The boys were having a great time between embracing the many food choices and being riveted to the game.
           As I looked at the boys and as I watched the game, I was struck by the similarities between the games I had watched.  The later game had more talent to be sure, this game was a touch crisper and the participants made more money doing it.  There is certainly more pressure and greater expectations up here but, at the core, it was still just a bunch of boys playing ball on a summer day.  All the players are thrilled when they get hits and dejected when they don't.  All the pitchers try and outsmart the hitters.  All the boys laugh and congratulate each other for good plays and bask in the camaraderie of the dugout.  When looking around the stands at either game, it is a bunch of people wishing they could play.  If not literally, then at least figuratively.  In our own ways, many of us want to be part of it.  We want to make the pivot at second and throw on to first to complete the double play.  We dream of connecting with an elevated fastball and driving it over the left center fence.  All baseball fields are fields of dreams.

Within those dreams are so many good parts of life and so many of life's lessons.  Things are more fun with friends.  Hard work is rewarded, except when it isn’t.  Failure is inevitable in the pursuit of success. Overnight success takes a long time and an immense amount of background sweat.  You’ll pay more for food if someone carries it to you.  Wear sunblock.  Don’t argue with authority.  Over half the battle is believing in yourself.  Sun, grass and play are the leisure trifecta.  Hope runs eternal in spring.  Tomorrow is a new game. 

Play ball.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Chemotherapy in Pets

            I heard it said once at a lecture by a veterinary oncologist that “cancer” was the scariest word in our language and that “chemotherapy” was the second scariest.  From many discussions over the years, I know that he was right. 

            Technically speaking, the term “chemo” means simply chemicals or chemistry.  Taking an aspirin is “chemo”.  Cancer chemotherapy may involve many different drugs, in an endless mix of protocols, to treat an array of different cancers.  It is just too broad a term to consider by itself.   The details of diagnosis and drugs dictate what the experience may be like and what we can expect as an outcome.  Of course, there are also many individual variations in response and how different creatures handle the medications.  The potential benefits can be profound.  The potential side effects vary widely. 

            We hope for ourselves, our families and pets to never hear either word and to never deal with a diagnosis of cancer.  The medical reality of course is that we do see cancer in pets and it is imperative that we know how to help these animals.  We have seen several cases of lymphoma, one of the most common cancers in dogs and cats, at our clinic in the past several weeks.  The diagnosis is devastating.  But, despite the aggressive nature of the disease, there is room for hope.  Chemotherapy can extend the quality and quantity of life significantly for most patients.  Toxicity and feeling sick on the chemotherapy drugs are a real concern and an important consideration.  But the vast majority of patients brave through therapy with few to no side effects.  A typical chemotherapy protocol for lymphoma involves 5 drugs used in 16 treatments given on a schedule over 24 weeks.  Two of the drugs are pills given at home and three of them require brief time at the clinic to administer.  Frequent blood tests are used to monitor patients.  We try to minimize the time animals are with us at the clinic.  

People commonly worry that their pet will feel sick for the whole time they are being treated.  We just would not tolerate that.  The animals can feel lethargic and even have some diarrhea or vomiting after some of the treatments but side effects are usually mild and transient.  Dogs and cats rarely lose hair.  If significant side effects occur, we may delay subsequent therapy or skip those specific medications when they come up again.  If necessary, we may even decide to forgo further chemotherapy.  Each successive treatment is an active choice based on the response to the preceding one.   It is a mantra of therapy, and cancer care in general, that we won't allow vomiting or diarrhea and we will alleviate pain.   Lymphoma is a disease we most often make a positive difference in the lives of our patients and owners.  There are many other cancers that we have effective treatments for as well.

I am also a strong advocate for complimentary medicine and alternative care.  My patients that receive acupuncture and herbal medicine from Dr. LenaMcCullough, along with chemotherapy, do the best.  In my experience, they have the longest survival, the fewest side effects and the best overall experience trying to combat their disease.  Visit her website, www.kingdomofbasil.com, for more information.

Should you ever face a cancer diagnosis for your pet, remember that there is hope and there are options.  I often say and truly believe that our pets have an enormous advantage over us.  They will never stop and ponder their diagnosis or prognosis.  They never look at the dog next to them and compare their good or bad fortune for the future.  They just take the next moment as it flows by and the tomorrows as they become known. 

May you never need any of this information.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners