REDIRECTED AGGRESSION IN CATS

Cats are just plain cool to watch. They can find the most unique and odd things to cuddle and exhibit complete bliss. But what happens when that turns into fatal attraction?



WHAT IS REDIRECTED AGGRESSION?

It happens when a cat is aroused by another animal (most commonly an outside cat, rarely a person or event), but is unable to access and focus the aggression towards the target. Think about an outside cat sitting on your window sill. The cat then redirects that anger at a bystander cat, dog, children, and even an owner.

ARE THERE SIGNS?

Agitation, aggressive body postures, hissing, growing, ears back, and back hair standing up are common observations by owners. As it progresses the refocused anger is directed to another pet, child, or even an owner and the attack can be quite vicious that it may require a doctor visit.

ARE THESE FEARFUL CATS?

They can be cats that exhibit anxious behavior. Often there are some minor episodes that escalate into major attacks due to any sight, sound, or source of arousal that leads to an increase in anxiety.

WHAT MAKES THESE ATTACKS ESPECIALLY DANGROUS?

It can be terrorizing, as often they can have a “ FLASHBACK” and attack the previous redirected anger with no outdoor provocateur in sight. In other words, a spontaneous attack on another cat, dog, child, or even owner can occur with no warning due to prior conditioning. In some multi cat houses, the situation can be irreversible and unpredictable.

CAN AN OWNER TAKE ACTION IN THESE CIRCUMSTANCES?

Yes, an owner must AVOID the cat until it calms down. If there are 2 pets fighting they must be separated without direct hand contact with the aggressive cat. It may take minutes, hours, or even days for the cat to calm down, so placing the cat in a safe room with food, water, and litter is advised.

ARE THERE DRUGS THAT HELP?

Yes, Paxil is often prescribed, but it is not a cure, and these cats are still unpredictable.

NAME SOME OTHER TECHNIQUES THAT MAY HELP!
Behaviorists recommend blocking access to the window with blinds, www.wallpaperforwindows.com, or gates to avoid visual cues. If possible, any motion-detector based water sprayer or noise should be utilized on the outside place where strays come to the windows. Put cat trees, food, bedding, water, and a litter box in the center of the house away from offending windows.

CAN THESE CATS BE DANGEROUS AROUND CHILDREN and OTHER PETS?

Yes!

Betsy T. Sigmon DVM, Diplomate ABVP, Canine & Feline

Hospital Director

Creature Comforts, Animal Hospital PLLC

Cary, NC



Many thanks to Fred Shipp for sharing the pictures of his cat Lily.

PULMONARY HYPERTENSION

Observing the festivities of the golden fairy sprinkling gold dust at the Artsplosure street fair:

Our backyard wedding preparations:

Southern ladies are obsessed with good hair. My whole life I have dealt with curly, frizzy hair, and not in an attractive way. For as long as I can remember I have developed a love /hate relationship with the top of my head.

  As noted in a childhood trip to the Statue of Liberty,

there is lifelong documentation I have lost the battle of hair. I have a bathroom tray of failed anti-frizz products that is one bottle short of being declared a toxic waste dump. Yet, today I read in the News and Observer headline “12 Products to Help Enhance Your Frizz”. What has happened? Frizz in the new mantra is embrace your natural textures. There is hope!

Why the hope discussion? Because many pet medical problems are considered hopeless. One, for example, is Pulmonary Hypertension.

WHAT IS PULMONARY HYPERTENSION?

It is high blood pressure in the arteries coming to and from the lungs. Experts believe it is secondary to restrictions within vessels leading to abnormal blood flow to other areas of the lungs. Although many patients have an unknown cause, risk factors include any lung disease, blood clots, tumors, heartworms, severe allergies, and heart conditions.

As a chronic condition, pulmonary hypertension ultimately leads to a back pressure of blood flowing from the right side of the heart and eventual right-sided heart failure. In addition, it decreases blood flow to the body from the left side of the heart.

MAY IT RESULT IN DEATH?

Yes, because the subtle changes in health may not be recognized quickly in dogs.

WHAT ARE THE SIGNS?

Symptoms include cough, pale gums, increased rate of breathing, respiratory distress, loss of appetite, and depression. Many will faint if they walk across a room. If the right side of the heart fails, the belly maybe distended.

ARE THERE CLASSICAL TESTS?

Once stabilized, chest x-rays (radiographs), bloodwork, sound waves of the heart (echocardiogram), Doppler blood flow, and the measuring of pressures.

TREATMENTS?

It can be a challenge to treat. Oxygen therapy and Viagra (sildenafil) to reduce pulmonary hypertension and pimobendin are among the treatment medications. Identification and treatment of the primary cause is key.

PROGNOSIS

Control, but not cure.


DO PEOPLE GET A SIMILAR DISEASE?

YES



Betsy T. Sigmon, DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Creature Comforts Animal Hospital

Cary, NC

DYSBIOSIS: BACTERIAL OVERGROWTH IN THE GUT

After spending a weekend in Auburn, Alabama attending my 35th veterinary school class reunion, it seemed full circle from a previous life. 

I revisited 40 years later, Callaway Gardens and President Roosevelt’s Little White House in Warm Springs, Georgia. 

As a special added moment, I went back to Auburn University flight school, where I performed my first solo in a Piper Cherokee. 

The full cycle of revisiting spring in the Deep South is something to celebrate.

Sometimes things do get out of balance. Tragically sometimes it is a car accident. 

In my day to day, it can be intestinal issues of my patients and an overgrowth of the wrong bacteria in the gut.

WHAT IS INTESTINAL DYSBIOSIS?
This is an imbalance of the intestinal bacteria associated with many GI disorders. Irritating bacterial toxins maybe produced or there may be a loss of protective good bacteria to provide balance for gut health. 

WHY IS THERE A SUSPECTED LINK OF DYSBIOSIS AND OVER USE OF ANTIBIOTICS in CHILDREN?

Besides the obvious concerns about drug resistant bacterial developing, this imbalance is suspected to be associated with development of allergies, obesity, diabetes mellitus, and inflammatory bowel disease (Crohn’s) in adult. In addition, dysbiosis may lead to destruction of important enzymes in the intestinal wall, damage to important proteins that carry material through intestinal wall for absorption, and competition for nutrients such as Vitamin B12 leading to chronic weight loss & diarrhea.

I THOUGHT ALL BACTERIA WAS BAD?
According to Jason Tetro, a Canadian microbiologist in his book “The Germ Code,” only 0.01% of the thousands of bacteria that regularly interact with humans cause infection. It is estimated that there are 100 trillion microbial cells in the GI tract. A balance of gut bacteria regulates the immune system, helps in mounting a defense against bad bacteria, and provides nutritional benefits. 

WHAT IS THIS ABOUT GERM WARFARE AND CERTAIN BACTERIA IN THE GUT MAY FIGHT CANCER?
Recently, in magazine Scientific American, the influences on the immune system of gut bacteria were noted. In the mice study, Bifidobacterium bacteria seemed responsible for improved anti-tumor activity. In another study, Bacteroides bacteria presence would help determine how well a new immune-therapy drug (check-point inhibitor) worked. However, giving oral antibiotics to these mice during the clinical trial wiped out the anti-cancer drug effectiveness. 

HOW CAN DYSBIOSIS BE DIAGNOSED?
Texas A&M GI lab has a new fecal test to identify harmful bacteria in the gut called the DYSBIOSIS INDEX that maybe used in cases of chronic intestinal diseases.

TREATMENTS FOR DYSBIOSIS?
Novel diet trial, probiotics, antibiotic trial (tylosin), and then anti-inflammatory medications

 
WHAT ARE SOME POTENTIAL USES IN THE FUTURE?
This test maybe used to screen the feces of normal dogs in order to select donors eligible for fecal transplantation (place in chronic diarrhea patients). 

Betsy T Sigmon, DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline
Creature Comforts Animal Hospital
Cary, NC

LEAD POISONING

I traveled earlier this month to Philadelphia for the flower show where this year’s theme was the national parks.

Listening to the local news, there was a lot of concern voiced about the safety of the aging, municipal water supplies in response to the recent headlines out of Flint, Michigan.

WHAT ARE SOME POSSIBLE SOURCES OF LEAD?

Lead based paint in older homes, older linoleum floors, and contaminated soil (then licking paws and fur) are major sources.  Lead can also be obtained via other sources: toys, fishing tackle, drapery weights, and improperly glazed ceramic food or water bowls (imported from Mexico or China) http://www.cfsan.fda.gov/~lrd/fdaact.html#lead.

Water contamination via lead pipes has rarely made headlines until recently.

WHY WERE LEAD PIPES & SOLDER (to connect copper pipes) USED PRIOR TO THE 1980’S?

Going back thousands of years, lead pipes resisted pinhole leaks AND WERE soft enough to form shapes to deliver water efficiently. 

AS CONCERN IS VOICED FOR CHILDREN, WHY ARE PUPPIES AT HIGHER RISK?

They are more likely to show signs due to chewing on foreign objects, greater intestinal absorption rates, and increased toxicity to the brain.

DEFINE “TENNESSEE LEAD POISONING.” IS BUCKSHOT A RISK TO CAUSE LEAD TOXICITY?

Pictured below are lead pellets found on the radiograph of a dog from a pellet gun and shotgun.  NO, buckshot does not elevate blood lead levels. Lead is only absorbed out of an acid environment (GI tract, joints) leading to poisoning.

WHY THE SUDDEN NOISE ABOUT LEAD POISONING IN MUNICIPLE WATER SUPPLIES?

As a cost cutting measure, the city of Flint, Michigan cut off Detroit as their water supplier and switched to the Flint River as a source. THE INAPPROPRIATE CHEMICALS UTILIZED IN THE FLINT WATER WORKS’ FILTRATION LEACHED LEAD OUT OF THE PIPE LINING AT AN ALARMING RATE. Unfortunately, there are probably hundreds of cities, in the USA that have a silent risk.

HOW HIGH IS THE LEAD LEVEL IN FLINT, MICHIGAN?

From what I can gather about the Flint issue, the levels are still in the part per billion (ppb) range (5 to 1000 ppb depending on the reference). THE EPA SAYS ANYTHING OVER 15 ppb is unacceptable.Two Flint dogs recently tested positive for lead toxicity. It’s the state’s first lead toxicity cases involving dogs in five years.

SO WHAT IS CONSIDERED TOXIC ENOUGH TO CAUSE LONG TERM PROBLEMS?

This is where it gets confusing, as long standing thoughts are that no ill effects occur until levels rise to parts per million. So, to put it in prospective, I will use the data for pets as they are important household sentinels

<10 mcg/dl (0.1 ppm) baseline "normal"

15-20 mcg/dl (0.15-0.2 ppm) --suggest exposure to environmental lead

but not toxicosis

20 mcg/dl (0.2 ppm) --supportive of toxicosis in birds if accompanied by appropriate clinical signs

30-35 mcg/dl (0.3-0.35 ppm) --supportive of toxicosis in mammals if accompanied by appropriate clinical signs

50 mcg/dl (0.5 ppm) in birds--diagnostic for toxicosis

60 mcg/dl (0.6 ppm) --diagnostic for toxicosis in mammals (dogs, cats, people, etc.)

ppm = parts per million

So when I read of outrage in the news when a child’s level is 6.5 mcg/dl or 0.1 ppb, I am confused if the chart above is inaccurate or if this is a crisis blown out of proportion. I believe that story needs to be investigated from a scientific, not political, standpoint.

It is now accepted that there is NO safe level of lead for humans, and I would presume that's also true for mammals and birds .

EXPLAIN WHY THAT CAN BE CONFUSING TO ASSUME ALL IS GOOD!

Blood levels are not that reliable, especially for longer-term exposure, since lead will ACCUMULATE outside the bloodstream in bone, nervous system, and other organs (replacing Ca++ in bones and other organs, including the nervous system). Unfortunately, I think there's no good alternate testing, although hair samples are being investigated.

ARE THERE COMMON SIGNS OF LEAD POISONING IN PETS?

Gastro-intestinal signs, behavioral changes, and neurological signs with slow onset in chronic exposure.

My SOAPBOX ON THIS ISSUE!

There seems to be a strong economic and political motivation rather than pure science to explain the risk levels of lead. Blame is shared among many agencies to reach solutions.

DISCUSS OPTIONS FOR TREATMENT IN PETS SHOWING SIGNS.

The two chelators (BINDERS) of choice are calcium EDTA injections and oral succimer.

PREVENTION TIPS FOR PETS

Use stainless steel bowls for pets made in the USA.  In at risk situations, consider filtered water for your pets; if not an option then run faucet 3 to 5 minutes before using the water in systems at risk.

HOW CAN YOU TEST WATER IN WAKE CO, NC? Goals?

Lead levels below 15 ppb

Well water testing: http://www.wakegov.com/water/wells/pages/watersampling.aspx

Municipal water supplies:  www.epa/gov/ccr

Betsy T. Sigmon, DVM, Diplomate ABVP, canine and feline practice

Creature Comforts Animal Hospital

Cary, NC

Cranial Cruciate Ligament Injury: the ACL is suspected to be Torn

In day to day lives, injuries to joints, muscles, and tendons are common occurrences. Sometimes these are acute after a traumatic injury. Pain and lameness affect our ability to work or simply move around the house. In the long term, injuries can be debilitating and irreversible. Fortunately, humans can verbalize their discomfort or pain. Pets have similar issues; yet, their ability to tell us can be limited. This requires us to observe body language.

WHAT IS THE MOST COMMON INJURY LEADING TO HIND LIMB LAMENESS IN DOGS?

Cranial cruciate ligament disease.

COULD YOU BETTER DEFINE THE CRANIAL CRUCIATE LIGAMENT (ACL)?

It is the primary ligament that stabilizes the knee (stifle). As it degenerates, it leads to pain, instability, and arthritis.

IS THERE A COMMON DENOMINATOR OF OWNERS WHO PRESENT COMPLAINTS?

Lameness in one or both hind legs, that can be acute or chronic, with the affected leg being held up or in what is commonly called the “tippy toed stance." It may get worse with exercise and improve with rest. Unfortunately, it may be more difficult to diagnose if it occurs simultaneously in both rear knees at the same time. The knee is kept flexed, rotated out, and appears swollen or puffy. A pet may sit asymmetrically to protect the painful knee.

ARE THERE SIGNS THAT VETERINARIANS OBSERVE IN RADIOGRAPHS?

Yes, it has some classic radiographic presentations: swelling, joint fluid accumulation, and eventually arthritis.

IS IT TRULY AN ACUTE INJURY?

Although it can appear in many dogs acutely, more often the radiographs indicate degenerative changes meaning a silent, chronic, compensated problem is suddenly acutely exacerbated.

WHAT IS THE DIFFERENCE BETWEEN A PARTIAL AND A FULL ANTERIOR CRUCIATE LIGAMENT TEAR?

A partial tear will often appear to have more stability to the joint (less buckling or veterinarians say “lack of a drawer sign”) as in one joint the shin (tibia) sliding against the thigh(femur) bone. In either case, arthritis or degenerative joint disease can be present depending on the duration of the problem.

CAN THIS DEVELOP IN CATS?

YES, but more commonly due to trauma.

ARE THERE CERTAIN DOG BREEDS AT RISK?

In dogs, it is more common in large breeds: Rottweilers, Labrador Retrievers, Newfoundlands, Boxers, Golden Retrievers. However, it can occur in any dog.

WHAT ARE THE RISK FACTORS?

Obesity, inactivity, over activity, trauma, medical conditions that weaken joints/immune system, confirmation, collagen degeneration, and genetics of the breeds mentioned above.

DOES NEUTERING AN ANIMAL INCREASE THE RISK?

There is controversy in how much is lifestyle versus the hormonal protection from remaining intact male (not neutered).

ARE THER OTHER DISEASES THAT CAN LOOK SIMILAR?

Slips or patella (knee cap) luxation, hip dysplasia, lower spine or lumbar-sacral degeneration, bone tumors, sprain of groin muscles (Iliopsoas strain), infectious joint disease, immune mediated disease, and torn meniscus can look similar. In cases where both knees are involved, the weakness can mimic a neurological disorder.

DISCUSS THE RECOMMENDED TESTING?

After the physical exam, bloodwork, radiographs, and possible testing for infectious diseases are the most common. Occasionally joint taps will be recommended.

NORMAL RIGHT KNEE

ABNORMAL KNEE

WHAT ARE THE ACUTE MANAGEMENT TOOLS?

Pain medications (NSAIDS), reduced food intake, and exercise restriction for a month. Fifty percent of dogs under 30 pounds and most cats will return to full function with rest, while only 20% of large dogs will be okay without surgery.



ARE THERE SURGICAL TREATMENTS?

Surgical management is considered the standard of care with an 85% success rate. The results can vary based on the age of the pet, weight, and degree of pre-existing arthritic changes. No single treatment is felt to be superior. 

There are 3 main types.

1. Intra-articular (within the joint) surgery to create a new ligament.

2. Extracapsular (outside the joint).

3. Biomechanical surgery that changes the angles of the knee. Examples include tibial plateau-leveling osteotomy(TPLO) and tibial tuberosity advancement(TTA).

 Newer, experimental treatments investigate the use of stem cell implants.


IS THERE FOLLOW-UP CARE?

Weight loss, pain medications, REST for eight to 10 weeks, followed by an incremental increase in exercise levels (rehabilitation), and monitoring for relapse of use of the leg(limping), infection, or pain. 

Betsy T. Sigmon, DVM, Diplomate American Board of Veterinary PractitionersCreature Comforts Animal Hospital

Cary,NC

Staphylococcal bacterial skin infections, Methicillin Resistant Staph, and New Skin Treatments

While attending one of the largest veterinary conferences in the world, a few glaring and concerning facts were presented about the state of antibiotics in the human and veterinary worlds. One of the most common challenges I have faced each day in the last 10 years has been Staphylococcal skin infections obtained after scratching or itching. Recently, it has been noted that many of these infections have become resistant in cultures to some of the more commonly prescribed oral and injectable antibiotics. 

WHY HAS ANTIBIOTIC PRODUCTION DECREASED 75% since 1983 IN THE USA?

There is not a lot of profit behind the development of new, occasional-use antibiotics versus the daily use of cholesterol lowering drugs (statins) that people take each day. Government agency guidelines recommend antibiotic use to be limited to only to severe cases, and that limits the ability of manufacturers to recoup costs. Used appropriately, antibiotics should be used for specific, targeted, bacterial infections and for a short period of time. 

 WHAT IS THE DIFFRENCE BETWEEN THE STAPHYLOCCOCAL DRUG-RESISTANT SKIN INFECTIONS OF PEOPLE VERSUS THOSE IN DOGS?

Dogs have Methicillin-Resistant Staphylococcal Pseudintermedius (MRSP) and people have Methicillin-Resistant Staphylococcal Aureus (MRSA). They are not felt to be of  concern in cross infections unless an individual is going through chemotherapy, incurs severe bite wounds, or has a compromised immune system. MRSP was first noted in North America in 1999 and MRSA in 1961.

ARE THERE SOME CLASSICAL SIGNS OF STAPH SKIN INFECTIONS IN DOGS?

They often look like circular lesions, similar to that expected with fungal infections (ringworm).  Some are itchy; others start as a pimple (infected hair follicle) then spread out like the ripple created when a pebble hits a pond.

TOPICAL THERAPY IS REALLY BEING PUSHED IN THE TREATMENT OF SURFACE INFECTIONS. 

One of the biggest reasons for topical antiseptic therapy is because there has been no drug resistance reported to date. In the past they were considered adjunct treatments (used in addition). Now they are being recommended instead of antibiotics (except in extreme cases) since there are no new antibiotics for skin infections currently available. Topicals can kill even highly antibiotic-resistant bacterial strains. They must initially be applied daily.  Below is a picture of the Staphylococcal  groin infection (featured at right) at 2.5 weeks post treatment with topical therapy alone. 

NAME SOME EXAMPLES OF TOPICAL ANTIBACTERIAL PRODUCTS. Alternative ones?

Douxo Chorihexiderm shampoo, spray, mousse are excellent products. Others are using malaket anti-septic wipes,

mupirocin cream, and a novel product from the dairy industry to disinfect udders, Preva wipes. 

YOU MENTIONED PREVA WIPES. WHAT MAKES THEIR TOPICAL USE UNIQUE COMPARED TO OTHER WIPES?

From Bayer Animal Health, they are unique in that they contain Nisin, a naturally derived antimicrobial from Lactococcus lactis. It is a 6x8 inch wipe and is utilized as an adjunct, in-between treatment to shampoos and topical leave-on antiseptics.

HOW OFTEN WILL THE TOPICAL ANTISEPTIC SPRAYS, LOTIONS, OR LEAVE-ON MOUSSE NEED TO BE APPLIED TO INFECTED SKIN AREAS?

Daily topical skin application is required until healed. Then once-a-week application is necessary.

IS THERE A WAY OWNERS KNOW THE SKIN INFECTION HAS DRUG RESISTANCE AND MAY STILL NEED ORAL ANTIBIOTICS?

A skin culture. 

WHY ARE ESSENTIAL FATTY ACIDS SUCH AS FISH OIL PRESCRIBED?

It is believed they have weak anti-inflammatory effects and may help boosts the outer skin layer function (epidermal barrier). In addition, this may lower the dose of oral anti-histamines and steroids due to lower itching. 

THERE IS A LOT ONLINE ABOUT EPIDERMAL BARRIER FUNCTION AND TOPICAL PIPETTE PRODUCTS SUCH AS DOUXO ANTI-SEBORRHEIC OR THE ALLERDERM LINE. HOW IS THIS SPECULATED TO WORK?

Topical lipid emulsion preparations may normalize the outer skin barrier and inflammatory leaking between cells of the epidermis that perpetuate itching, odor, and secondary infections due to allergies.

ARE THERE ANY OTHER FACTORS THAT INCREASE THE RISK OF DRUG RESISTANT SKIN INFECTIONS?

Hospitalization, surgery, prior antibiotic use in the last 30 days, or the repetitive use of antibiotics. 

IS THERE A BIG LESSON HERE?

When possible, perform a cytology for yeast and bacteria, a skin scrape for mange, and  fungal cultures for any significant skin infections. In repetitive infections, culture the skin and look for underlying causes.  Washing your hands several times a day and pets once a week is also an excellent recommendation.

New treatments such as probiotics to create healthy bacterial environments that overgrow the bad bacteria and the research of viruses that kill bacteria (phages) are on the horizon.  Some guidelines are noted in hwww.wormsandgermsblog.com/files/2008/03/vde121181.pdf

HOW SERIOUS ARE DRUG-RESISTANT INFECTIONS IN THE USA?

The CDC reports a minimum of 23,000 people die each year as a direct result.  100,000 die from related complications.  Two million people contract such infections each year. Yet, over half of the antibiotics prescribed are considered unnecessary. In summary, drug- resistant bacteria and viruses are considered the sixth leading cause of death in the USA, and the numbers are rising. 

Betsy T. Sigmon, DVM, Diplomate ABVP, Canine & Feline

Hospital Director

Creature Comforts Animal Hospital

Cary, NC

BIG VAROOM FOR RAY PRICE HARLEY DAVIDSON AND BIKER BOOT CAMP YESTERDAY. In addition, special thanks to Ms. Ray Price for her hospitality and the courteous treatment of all attendees by her employees. 

Yes it is winter in all its glorious beauty!