Doctor, What Should I Feed My Cat?

This is a common question posed to veterinarians.  I just finished reading an excellent newsletter from Drs. Wackerbarth and Vaughan at the Hyperthyroid Treatment Center in Edmonds on feeding hyperthyroid cats.  I credit them with the following specifics and for prompting me on the subject.  For more of their information, visit them online at www.felinehtc.com.  Feeding hyperthyroid cats is similar to feeding most older cats so we can consider it in a general sense and in subsequent blogs we will look at feeding for specific geriatric diseases like thyroid disease and kidney failure.

We need to always remember that cats are obligate carnivores.  This means that they rely on the nutrients in animal tissues to meet their nutritional needs.  In the wild, a prey diet consisted of 50-70% protein,  30-50% fat and less than 2% carbohydrates.  A significant portion of their water needs were also met from their diet.  Cats are designed to use proteins and fats as energy, so they need a lot of protein in their diet.  When omnivores like dogs and humans ingest insufficient protein, they can conserve amino acids and use carbohydrates for energy.  Cats cannot switch from protein use.  When their diet is deficient in protein, they will burn their own muscle tissue for energy.

Cats also have specific amino acids that must be in their diet.  Cats don’t have the ability to synthesize arginine, cysteine, methionine, and taurine.  They must eat meat based proteins so they have the full complement of amino acids carnivores require.  Plant based proteins found in higher levels in dry foods are of low biological value for cats for this reason.

Feline metabolism lacks many of the enzymes and pathways needed to utilize carbohydrates.  They can’t store their glucose like omnivores, so they are more hyperglycemic after a meal and carbs that aren’t used are stored as fat.  Cats on higher carbohydrate diets are more prone to diabetes and obesity.

Fats provide energy and are responsible for a diets palatability.  Meat based diets with animal fat provide appropriate fatty acids and needed hormone precursors.

Animal proteins are more expensive than virtually any other ingredient in pet food.  Many canned and all dry foods include plant based proteins and not enough meat.  Whole grains, glutens, and soy are of low biologic value to the cat.  Remember that “grain-free” does not equal “carb-free”.  Potatoes, peas and soy are all “grain-free”. 

Canned foods are energy dense foods.  This is great for thin cats but can lead to weight gain.  So in heavier cats, portion control becomes more important.

So, what should we feed our older cats?

On a dry matter basis, 40%+ meat based proteins, about 50% fat, and less than 10% carbohydrates. {The Feline Nutrition Awareness Effort website has an explanation of Dry matter basis and a calculator so foods can be compared accurately.  http://fnae.org/dmb.html}

Any canned food is better than any dry food.  High quality canned foods with high levels of animal based proteins that contain little to no fruits, vegetables, or grains are the best choice. 

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

Outreach Chairman, American Board of Veterinary Practitioners

If you could see into others' hearts

     I was commuting in from Vashon several Monday mornings ago.  It was a warm, beautiful morning and I got placed on the very back of the upper deck pointing uphill on the ramp.  Anyone who does a ferry commute knows that is one of the worst spots.  It is too difficult to be comfortable on the incline and hardened island commuters do not go up on deck without a very good reason.  So I sat on the incline, eating breakfast, as I do every morning on my way to work, with my windows open.  I listen to sports radio if the Mariners win and music if they don't.  I listen to a lot of music.  A ferry worker stopped and asked me a question about my car.
     We talked and he told me about cars he had owned and his boat.  He told me about living on his boat and how expensive the Vashon marina would be to moor his boat at.  He told me about his wife.  They had bought the boat together.  It was quickly clear that she was gone now.  He told me later that she had died of cancer 7 years or so ago.  He knows, as part of his being, that he will see her again.  He was such a nice man.  He has literally directed me hundreds of times on the boats and we have never spoken.  We acknowledged each other for a few days after but are now back into our usual roles.  I am a faceless commuter.  He's the worker directing me.  Eye contact is not made.  It is ok to go back to our roles.  We both have our days to manage and get through.
    We bonded for that point in time - two guys talking cars.  He had a story.  Everyone has a story and everyone wants to tell their story.  Everyone has sadness and strife.  The worry in the others around us is unknowable.  It is knowable that it is happening.  A wise man said once, "When you meet a person, treat him or her as if they are in trouble.  You will be right more often than you are wrong."

    A few weekends ago, we held our clinic management retreat.  Sarah, Kas, Johana, Andrea, Beth and I met and talked about our parts of the clinic.  We talked about this very issue and we watched a short video together from the Cleveland clinic called "If we could see inside others' hearts".  It is profound and a real tear-jerker.  Watch it if you have a minute.

https://www.youtube.com/watch?v=IQtOgE2s2xI

It makes one want to vow to cut people some slack, make eye contact, say good morning, thank you, and you're welcome, and try not to take it personally when someone is difficult or unpleasant.  Everyone has their stuff.

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

Outreach Chairman, American Board of Veterinary Practitioners

Taking Your Cat to the Veterinarian

Routine yearly healthy pet examinations are part of good health care and can allow your cats to have longer, more comfortable lives.  But, many cats dislike coming to the clinic; I would even say most.   My cat "Mango" for instance loathes the trip in - no snacks, no litter box, poorly responsive attendants when he inevitably needs to use the non-existent litter box.   The challenge starts with getting cats in the carrier and getting them to the clinic.  If we make that step easier, everything improves. The following information is reprinted from the American Association of Feline Practitioners (AAFP) website.  They are an ongoing wealth of kitty information.

• Cats are most comfortable with the familiar, and need time to adjust to the unfamiliar.  The visit to the veterinarian is often difficult because the carrier, car, and the veterinary hospital are unfamiliar. Your cat will need time to become familiar with new situations, people and places.
• Stay calm. Cats can sense our anxiety and frustrations, and this may cause them to become fearful or anxious.
• Cats do not learn from punishment or force. Give rewards to encourage positive behavior. Try to find treats that your cat thinks are delicious and are motivating.  If your cat is sitting calmly in or near a carrier, give a treat. Likewise, rewards can be given to help your cat become familiar with types of handling that may happen at the clinic.  Play or affection may also be seen as rewards.
• The goal is for your cat to learn to associate the carrier with positive experiences and routinely enter voluntarily.
• Make the carrier a familiar place at home by leaving it in a room where your cat spends lots of time.
• Place familiar soft bedding inside the carrier. Bedding or clothing with your scent can make them feel more secure.
• Place treats, catnip or toys inside the carrier to encourage the cat to enter the carrier. At first, you may see the treats removed from the carrier at night.
• It may take days or weeks before your cat starts to trust the carrier. Remain calm, patient and reward desired behaviors.
• If you still have trouble, you may need to assess the carrier itself. 
• If your cat needs to go to the veterinarian right away, and is not yet accustomed to the carrier: 
• Start by putting the carrier in a small room with few hiding places. Bring the cat into the room and close the door. Move slowly and calmly. Do not chase the cat to get it into the carrier. Encourage the cat with treats or toys to walk into the carrier.
• If your cat will not walk into the carrier, and your carrier has an opening on the top, gently cradle your cat and lower it into the carrier.
• Another option is to remove the top half of your carrier while getting the cat to go into the bottom half, and then calmly replace the top.
• Consider use of synthetic feline facial pheromone (Feliway®) analog spray in the carrier at least 30 minutes prior to transport to help calm the cat.

Coming Home – Cats are very sensitive to smells, and unfamiliar smells can result in one cat no longer recognizing another.  Aggressive behavior can occur when one cat senses another as a stranger. Consider the following.

• Leave the returning cat in the carrier for a few minutes to see how all of your cats react.
• If all cats appear calm and peaceful, let the returning cat out of the carrier.
• If you sense tension between the cats, or if previous home-comings have resulted in conflict, keep the cat in the carrier and take it to a separate room to avoid potential injury from an upset cat.  Provide food, water and litter box for a minimum of 24 hours while it regains the more familiar smell of home.
• If there is still stress after this time, contact the clinic to discuss slower introduction or medication.
• Feliway can help provide the sense of familiarity.
•  For future visits:  Use familiar bedding or clothing with your scent, as it retains the smell of home and helps with reintroduction.  Use Feliway.  Consider bringing both cats to the clinic together. This can prevent future conflict because both cats will carry the scent of the clinic.

The best carriers are inexpensive hard-sided carriers that open from the top and the front, and can also be taken apart in the middle.  An easily removable top allows a cat which is fearful, anxious or in pain to stay in the bottom half of the carrier for exams.  We can often do the exam in the bottom of a well-designed carrier.   Avoid carriers that require a cat to be pulled from or dumped out for an exam. Choose carriers that are sturdy, secure and stable for the cat, as well as easy for you to carry.  Some cats like to see out, whereas others are less anxious when the carrier is covered with a blanket or towel.

You are an important member of your cat’s healthcare team. You can be instrumental in helping your cat have a positive clinic visit and improved healthcare.

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

Outreach Chairman, American Board of VeterinaryPractitioners

Milestones Reached - Thanks Sarah

I found out the other day that I missed an important milestone.  Our head technician Sarah just passed the 15 year mark at the clinic.  Remembering important milestones and personal details of those close to me is on a list of talents I do not  possess.  The list is long and also includes things like singing in tune and dunking a basketball.  Sadly, I may work a lifetime on the list and never improve.

Sarah started at the clinic in 1999 as a volunteer and has essentially been with us the whole time we have owned the clinic.  She rose through our ranks and has been our head technician for a long time.  She is also one of the most skilled technicians I will ever work with.  She has had stints of being my surgery technician and she is as efficient and caring as she is talented.  

She grew up here with us.   She has been there for the growing pains of us becoming bosses.  She was there when were first figured out to have staff meetings every week and when we started the staff newsletter.  She has watched us expand and learn new techniques and was instrumental in developing our policies and protocols for many medical procedures such as chemotherapy.  Sarah watched us fix up the old building, contemplate its replacement, design the new building, move into the new building, and figure out life in the new building.  

There has been struggle and triumph.  I watched as she persevered and studied to became a licensed technician.  I was and am so proud of her achievement.  We have navigated staff upheaval together.  She is a breast cancer survivor.  She is married to a wonderful guy who is her sole mate.   She is an accomplished violinist and I have had the pleasure of accompanying her on the piano.  We once played at an adult music camp together.  She knows more music than anyone I know.  No one loves a “Highlights” magazine joke more than she and she is so funny and shares my sense of humor. She is my friend. Currently, she is pregnant with her first child.

I wish I could manage to acknowledge and thank all those who help me and make my life easier.  It is a daunting task sometimes and I can get caught up in just keeping up.  Sarah has always taken care of me and our patients.  She makes me a better person and doctor and she makes the clinic and those around her better.   

Thanks Sarah, for so many years of dedication and humor and for all that you do for all of us.  I wouldn’t have wanted to try and do this all without you.

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

Outreach Chairman, American Board of VeterinaryPractitioners

The Father Daughter Dance

"Sometimes you can have a whole lifetime in a day and never notice that this is as beautiful as it gets."

·                                 Robin Williams in “The World According to Garp” 

Saturday night was the annual Father/Daughter Dance on Vashon.  My daughter Aubrey and I went for the 6^th time.  She is 17 and I am so very glad she will still attend such an event with me.  This year we had dinner and went to the dance with Steve and his daughter Quinn.  Steve is married to Kristin, one of the clinic’s excellent front staff.  The dance is a splendid event where the daughters get their dads dressed up and go to dinner and then see them attempt dancing.  The last part is not necessarily the good part.  The dance was started by some dads on the island 8 years ago and was sold out again this year.

It was held at the Vashon Country Club and while the dance floor is small there are extensive golf course grounds for the little girls to run around when not dancing.  There is also a lovely deck area where the dessert options may be enjoyed.  The social event is a mix of daughters dancing with dads

and daughters dancing with friends, little girls running about and the non-dancing dads off to the side discussing sports and yard maintenance.  Steve and Quinn and Aubrey and I danced a lot of the night away.  The dance floor area was essentially as hot as the internal core of the sun so we did take occasional golf course breaks.  Steve and Aubrey and I have some rudimentary swing dancing ability and we were not afraid to showcase it.  Aubrey and I have been swing dancing together since she was very little.

I am keenly aware that the remaining number of these dances for me is dwindling.  Aubrey will be a senior next year and has great things to do with her life.  These will most obviously soon involve not living with her parents.  I am both profoundly proud and sad as I watch her write the last pages of her childhood.  It is about living and enjoying the moments and this was a wonderful moment.  I hope to never look back and worry that I didn’t appreciate the moments.  I appreciate them beyond measure.

Quinn is only 9 and this was their first father daughter dance.  I hope Steve has many more.

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

Julie’s Tree

     It is early Saturday morning and I am contemplating the endless “to do” list that is my life.  All of Comcast is apparently down so I can neither work on stuff nor watch “Sports Center” to see how many times I can catch a replay of the Mariners walk-off win last night.  It has made me pause. My golden Retriever “Violet” and I are having a cup of coffee on our front porch.  To be most accurate, she peed in the yard and rolled in the grass.  We probably both could have gone either way but she doesn’t like coffee and social convention restricts me from her activities.  In between things, she checks in with me to remind me that she loves me and that I am the most important person ever in her life.  I try not to get a big head.  That is what she tells everyone.

     I am looking out on a tree we planted when we moved to our house in 1994.  I don’t actually know what kind it is.  It is a little pathetic that I don’t know; the tree has been in our front yard for 21 years.  When the tree was very small, it was given to us by the dad of a dog named “Julie”.  Julie was a patient of mine that was lost in the early 90’s to Autoimmune Hemolytic Anemia (AIHA).  For whatever reason (infection, drug exposure, cancer, . . .), a patient’s immune system decides to attack its own red blood cells.  The disease is very serious and requires treatment with immunosuppressive drugs and transfusions.  Julie was treated aggressively but her disease was relentless.  Some of the case details are blurred by time but I remember how sweet she was.   I remember the relationship and the trust and can still feel the collective deflation during her decline.  Many patients do survive the disease and today we have better drugs than we did in 1992.  I wonder if she could have responded to the newer medicines.  I think likely not, considering how quickly her disease had progressed, but questions like that often haunt me.  The tree originally went home with Connie and Dr. King because Beth and I didn’t have a place of our own.  A few years later, when we bought our own home, Connie gave the tree to us.

     Julie’s tree is a fixture in my landscape.   I think about losing her and about how she would not have held a grudge for that.  She knew people who cared about her were trying.  Her tree makes me consider all the lives each creature touches and I wonder where her dad is today.  He would be happy to know that she lives on in her tree.  Her presence in the serenity of her corner of our yard gives me hope that nothing good ever truly dies.

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

Goodbye Friends

We have lost some wonderful longtime patients in the last weeks.  Death is part of medicine and thus our world.  The realities of lifespan play out daily in veterinary medicine.  But, things cycle and sometimes it is harder than others.  I have contemplated blogs honoring my favorite patients many times.  In the interest of fairness, I have not written one.  I didn’t want to leave anyone out.  I have many wonderful patients and owners that make my days worthwhile that I won’t have time or space to mention.  I would never want Prince Charming, Mooshu, or Inca’s moms' to wonder if those special creatures mattered to me.  It just struck me that some of my closest patients were lost in such a short time of late.  These are animals and owners that I have spent countless hours with over the years.

Dingo (2000-2015)

Sundance died last Friday.  Fiona the Friday before that.  We lost Bentley and Hennessey just before that.  Sundance’s brother predeceased him by just a few months as did Bentley’s brother.  These are all animals that I cared for through major medical illness and had come to know well.  They were my friends.  So are their owners.  Everyone at the clinic knew them all well and they had friends in the staff as well.

Sundance and Bentley both were fighting cancer.  Sundance was oblivious to his predicament and wagged his tail throughout his treatment and hospice care.  Bentley’s cancer struck like lightening.  He was also oblivious, as he always was, to infirmity.  He just moved on an enjoyed his time.  Fiona was a funny little creature.  I knew her the least amount of time.  She had been a foundling with a long list of issues.  She persevered though and was adorable.  Eventually, there was just too many issues stacked against her.  Hennessey beat them all for number of ailments conquered.  She had tackled addison’s disease, brain cancer and aspiration pneumonia, among others.  In the end, too much was stacked against her as well.  All of these wonderful beings lived out long lives with their attentive owners.  With each one, we had to contemplate their end of life plan.  With each of their parents, we talked about when it would be time to let them go and how to tell.  I told them, as I often do, that if they did not know if it was time yet, it was because it was not.  When we care so much for another being, we usually come to know how to proceed.

People often empathize with us that this must be the most difficult part of the job.  I appreciate the sentiment but it is not.  It is worse to not make a difference when you think you could.  Being there at the beginning of their lives and taking care of their puppy and kitty needs, then navigating illness and injury throughout life to cruise into geriatric issues is the general practitioners nirvana.  Getting to know their people over a 15 year, or so,  lifespan of their friend, contemplating, diagnosing, treating and fixing ailments is what drives me.  The fact that death will be there at the end is part of the deal.  It is my job to help with all of it.  I want to be there.  Counseling and considering options is an important part of my role and it completes the circle.

I just needed to take a moment and say goodbye to those friends.   You made a difference in our lives.  Thanks for sharing some of your time with me and trusting me and making me want to put my stethoscope around my neck each day.

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