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“My cat was a stray at 6 months old.  We adopted her.  She doesn’t want to use her litter box.  She only wants to eliminate outside.  HELP!” It is natural for a cat to want to use a soil-type substance for elimination.  For indoor cats, their “soil” is cat litter and using it is a behavior kittens learn from their mother.  It is unusual for a cat to actually have to be trained by humans to use a litter pan.  However, for a cat that has only known the outdoors, their “soil” literally is soil, and they may not recognize commercial cat litter as an acceptable potty substrate. To help train your litter box challenged kitty, you should purchase multiple litter pans in a variety of sizes and configurations to determine what your cat prefers.  Hooded boxes can be considered, but many cats prefer an open litter pan, especially yours who now uses the great outdoors as her potty. Cats that live outside often do not like the confinement of a litter pan and need a large toilet area to entice indoor elimination.  In these cases, bigger is better.  You can cut a door in the side of a large plastic storage tub or use an under bed sweater box to provide a roomy bathroom area.  For an even bigger option to help really stubborn cats, try a child’s wading pool. In addition to offering options in litter pan size and shape, you need to provide a variety of types of litter for your kitty to try.  There are a wide range of choices, including clay litter, clumping litter, silica, plastic pearls, recycled newspaper pellets, wood shavings, etc.  There is even a litter called Cat Attract™ that contains a natural herb attractant to which some cats will respond. Litters also may be scented or unscented.  Each cat will have her own preference, but studies have shown that most cats opt for an unscented, finer grain clumping-type litter when given a choice. You should also determine if you cat has any favorite potty spots in the yard.  If so, scoop up some soil and material from those toilet areas and add it to the litter pans.  This material can carry the scent of previous eliminations and may attract your cat to her indoor toilet more readily. Litter box placement is also important.  Choose a site that is easy for your cat to access, but is also out of the way of traffic and commotion.  Just like us, cats prefer to eliminate in locations that are quiet and have some privacy.  Laundry rooms may seem like a convenient, out of the way location for a litter box, but the noises from the washer and dryer can be frightening. Avoid areas with only one way in or out, such as a corner, so that your cat does not feel “trapped” when going into the litter box area.  You can also try placing litter pans in multiple locations throughout the home so your cat can choose the area most comfortable to her. Alternatively, you may need to confine your kitty to a single room with the various litter pans and litter boxes, even that children’s wading pool.  As your cat starts to use certain boxes and litter substrates, you can begin to eliminate those that she does not like.  If she will only use the wading pool, for instance, the next step is to very gradually introduce smaller and smaller potty boxes until one of reasonable size can be used.  Once she is consistently using a certain kind of litter pan and litter type, you can give her increasing amounts of freedom around the house and place some of her litter boxes in various locations. Cats are fastidious animals, constantly grooming themselves to keep clean.  So another important part of litter box training is making sure the litter pans are regularly maintained.  Waste should be scooped on a daily basis and litter should typically be completely changed out weekly.  The boxes should be cleaned with soapy water on a monthly basis.  Detergents can be off-putting to some cats, so be sure to rinse thoroughly with plain water after washing. With patience and a step-by-step approach, most cats can be successfully trained to use a litter box.  Remember that initially you need to go big and offer a variety of litter and box options to your kitty.  She should eventually find an acceptable replacement for her outdoor “potty box”.

I’ve been told that my dog, a 6 year-old Cavalier King Charles Spaniel, has a heart murmur. I am a bit confused about what the murmur means and what to do!

A heart murmur is an abnormal heart sound that can be heard when listening to the heart with a stethoscope. It occurs when there is turbulence in the flow of blood through the heart. There are a variety of diseases that can produce a murmur in the heart. However, the Cavalier King Charles Spaniel breed is predisposed to the development of mitral valve disease. To better understand mitral valve disease, a little anatomy lesson is needed. The heart has four chambers: two upper chambers called atria (a right and a left atrium) and two lower chambers called ventricles (also divided into right and left). In between each chamber is a valve that allows the blood to move forward through the heart, while preventing the blood from going in a backward direction.

The heart valve located between the left atrium and left ventricle is known as the mitral valve. When blood exits the lungs it enters the left atrium, where it is briefly held. The blood then travels through the mitral valve into the left ventricle. The muscle of this chamber contracts and produces high pressure, allowing blood to be effectively pushed out of the heart to the rest of the body.

With mitral valve disease, this normally one-way valve between the left heart chambers becomes leaky. The contraction of the left ventricle then causes some of the blood to flow backwards into the left atrium, instead of pushing all of the blood forward to the body. Since blood is now flowing in the wrong direction, turbulence is created in the heart. It is this turbulence that produces the abnormal sound of a heart murmur.

Although not true for every type of murmur, in mitral valve disease there is a correlation between the loudness of the murmur and the severity of the disease. Therefore, a loud murmur indicates a leakier valve, more turbulence in blood flow, and more significant mitral valve disease.

Over time the left atrium stretches to accommodate the extra blood. But eventually there is more blood than the chamber can handle, so blood backs up into the lungs causing fluid to leak into the air spaces of the lung. This condition is known as congestive heart failure. Clinical signs that can be seen with heart failure include coughing, exercise intolerance, lack of stamina, increased breathing rate and respiratory distress.

When a murmur is detected, further work-up is needed to determine if there are any changes in the heart which would require medical intervention. Baseline blood work and urine tests help determine the overall health of the pet. If medications are started, these values are also important when monitoring how the body is responding to those medications. Cardiac enzymes that are released in higher levels when a heart is damaged can also be measured in the blood.

A chest x-ray is used to determine the heart size and shape. It will also show if there is fluid building up in the lungs or enlargement of the vessels. The heart’s electrical activity, rate and rhythm can be evaluated by an electrocardiogram (ECG). An abnormal rhythm may require specific intervention and can affect your pet’s prognosis.

The best test to determine the overall function of the heart is an ultrasound, also known as an echocardiogram. Sound waves are used to observe the heart’s motion as it contracts and relaxes. The amount of blood pumped by the heart can also be measured. This test often requires referral to a specialist with advanced training.

Not every murmur requires treatment. If there is no enlargement of the heart or signs of congestive heart failure, starting medication early does not slow the progression of heart disease or improve survival. Once these changes are evident, however, there are a number of drugs that can be used to help heart function and reduce clinical signs.

In order to determine the significance of your dog’s murmur, you should have further cardiac work-up performed. Early diagnosis, regular monitoring, and appropriately-timed initiation of cardiac medications are key factors in the successful management of mitral valve disease. There is no cure, but appropriate testing and treatment can provide your dog with the best chance for a good quality life for hopefully years to come.

Many of my doggie patients seem to really enjoy visiting the vet’s office.  Whether it is the grand adventure of a car ride, seeing old friends and meeting new ones, or all of the dog “cookies” they get during their visit, their experience is most often a positive one.

Cats, however, are another story.  I do not think that many of my feline patients are telling their buddies, “Yippee!  I get to see my doctor today”.  The good news is that there are things you can do at home to help prepare your cat for the vet visit to make the experience as stress free as possible.

The American Association of Feline Practitioners has published a set of guidelines designed to make veterinary visits more feline friendly.  At an early age, if possible, start the process of adapting your cat to carriers.  The carrier should be seen as a positive, safe place.  Make the carrier a part of your everyday home environment, with soft bedding, toys, and treats or catnip placed inside the carrier.

Once your cat becomes accustomed to the carrier, start taking occasional short rides in the car.  Be sure to properly secure the carrier with a seat belt to prevent excessive jostling and help provide protection in case of a sudden stop, turn or accident.  A towel placed over the carrier may increase your cat’s sense of security.

If a vet visit is necessary and your cat has not been accustomed to the carrier, put the carrier and your cat in a small room with limited hiding spaces.  Your cat may seek the carrier on his own as a secure hiding space.  Taking the top off of a carrier lined with comfortable bedding may also entice your cat to enter.  Misting the carrier with Feliway, which is a synthetic feline facial pheromone spray, about 30 minutes prior to the trip can also comfort your cat and help relieve stress.

Taking your cat for “practice vet visits” may also be beneficial for some cats.  A trip to the vet typically involves such unpleasantries as needle pokes and rectal temperature taking.  It is no wonder that cats object!  Rehearsal visits should involve only positive experiences.  Bring your cat to meet the clinic staff and get accustomed to the smells and sounds while getting treats and extra pats and loving.  Reward all desired behavior.  Let your cat explore the exam room and feel comfortable.

While in the familiar surroundings of your home, practice performing some procedures that mimic what is done during a veterinary exam.  Handle your cat’s paws to prepare for nail trimming.  Massage and look into your cat’s ears and feel along your cat’s body and limbs in preparation for the physical exam.  Open your cat’s mouth in association with his favorite treat.  Getting your cat used to having his mouth opened can make future administration of medications easier, pave the way to tooth brushing, and facilitate oral exams by your veterinarian.  Ask your veterinary staff to demonstrate the proper way to perform these “practice exams” at home.

Cats can sense when you are stressed or nervous, which in turn can increase their anxiety.  Stay calm and remain positive.  Bring familiar toys, treats, food or bedding to make your cat feel more relaxed.  Give yourself plenty of time before your appointment to locate your cat and encourage him to enter the carrier on his own.

Despite your best efforts, there still will be some cats that become very aggressive and unmanageable during a veterinary visit.  In these instances, it is often safer and less stressful to administer anti-anxiety or sedative medications to your cat.  If you have such a cat, be sure to discuss your concerns with your veterinarian.

Finally, when your cat goes back home, he may be carrying unfamiliar objects (such as a bandage) or smells from the clinic on him.  Other household cats may not recognize him and could possibly even attack this invading “stranger”.  Bring something that smells like home to place in the carrier for the return trip.  Do not encourage interaction between cats until you know how everyone is going to react.  With some planning and practice, you can help reduce the stress associated with your cat’s visits to the veterinarian.

I was told my dog might have food allergies, but he has eaten the same food his whole life.  How can he now have a food allergy?

Unlike people, who may have an allergy to a food they rarely eat such as peanuts or strawberries, pets typically develop allergies to foods that they have been exposed to for prolonged periods.

In an allergic reaction to food, antibodies develop to a particular component of the food, usually a protein or complex carbohydrate.  It takes time for the body to develop these antibodies.  Therefore, it is most common for a food allergy to develop after eating the same brand, type or form of food for months or even years with no trouble.

Although a food allergy can cause GI disturbances in pets, most often the allergy manifests as skin or ear problems.  Food allergies are one of the itchiest conditions that pets can get.  In dogs, signs classically include chewing on the feet or limbs, facial or belly itching and ear infections.  Cats most often have itchiness or scabs around the face and neck areas.

Almost any food ingredient can cause an allergic response.  However, there are some more common offenders.  The top three reported food allergens in dogs are beef, dairy products and wheat, accounting for 68% of canine food allergies.  In cats, accounting for 80%, the top three food allergens are beef, dairy products and fish.

There is no gender predisposition to food allergies.  In dogs the reported age range is 4 months to 14 years.  However, up to one-third of cases may occur in dogs under one year of age.  The age range of affected felines is also broad, varying from six months to twelve years.  According to one study of cats with food allergies, nearly half the cats affected had developed signs of the disease by two years of age.

A pet with a food allergy often also has other types of allergies, such as flea allergies or environmental allergies (atopy).  In fact, up to 50% of dogs and 30% of cats with suspected food allergies have concurrent flea allergies or atopy.  So strict flea control is essential for any itchy pet to ensure fleas are not a complicating factor.

A food allergy can only be diagnosed by doing a test known as a food trial.  During a food trial, your pet is exclusively fed a special hypoallergenic diet for 8-12 weeks.  This diet contains limited ingredients including as a novel protein and a novel carbohydrate source (ingredients your pet has never been exposed to before, such as duck, venison, green pea, or rabbit).

A food trial has a very strict, but simple, protocol.  Your pet can have water and the special prescribed diet and nothing else.  Treats, chew toys, anything flavored such as certain types of preventatives, table scraps, etc. are completely off limits.  Giving you pet any of these things invalidates the feeding trial; so the entire family, friends and other visitors must understand and follow the rules for the trial to be successful.

If you pet’s itchiness and/or GI signs improve or resolve during the feeding trial, then the test is positive for food allergies.  To determine the specific food allergen, you can slowly reintroduce one ingredient at a time and see if that causes the itchiness starts again.

Most commonly, however, I follow the “if it ain’t broke, don’t fix it” rule, and continue with the hypoallergenic that resulted in improvement of the signs.  Sometimes it might take several food trials with different limited ingredients to find what is best for your pet, so patience and not getting discouraged are keys to success.

Southeast Texas and allergies seem to go hand-in-hand.  The warm climate is great for lush tropical plant growth, but not so ideal for those of us, people and pets, who suffer from seasonal allergies.  Last month’s blog addressed allergies in general.  As promised, this blog covers in more detail one of the three major categories of allergies in pet – atopy.

Atopy is the term used to describe environmental allergies in pets.  Such allergies may also be known as inhalant or airborne allergies.  Atopy is a very common type of allergy in dogs, second only to flea allergy dermatitis.  A pet that suffers from atopy has an exaggerated immune system reaction to certain, often otherwise harmless, substances.

Unlike people with allergies who breathe in their allergens, the most common route of exposure in pets is through the skin.  Therefore, the feet, armpits and groin regions are the most commonly affected in dogs with atopy.  Dogs may scratch, chew and lick these areas, which become inflamed and irritated.  These sites have less protective hair and have the highest allergen contact.  Dogs with atopy also often have itchy faces and may rub them along the ground or furniture.  Less frequently, dogs can be affected by inhaling allergens and experience respiratory signs such as red, watery eyes and a runny nose.

Just about anything in the environment can be the inciting cause for a particular dog’s allergies.  The time of year your dog has a worsening of itchiness can be a clue.  In Spring, tree pollens cause the most problems.  The summer months bring grass pollens and outdoor molds.  And Fall flare-ups commonly are due to weeds as well as outdoor molds.

Year-round itchiness can also be due to “seasonal” allergies.  House dust mites, storage mites, indoor molds, moths and cockroaches can all cause atopy.  Even fabrics have been implicated in environmental allergies.  I once had a patient who was allergic to cotton – not an easy fabric to avoid.

To determine the exact allergens responsible for your dog’s signs, allergy testing is needed.  There are two options for testing.  The first is a blood test which measures levels of circulating antibodies to a variety of allergens specific to your region.  This test can usually be performed by your local veterinarian and is best done during peak allergy season for most accurate results.

The second option for allergy testing, called Intradermal Skin Testing, typically requires referral to a veterinary dermatology specialist.  Your pet is sedated and an area of the body is shaved.  Then tiny amounts of allergens are injected into the skin and the resulting skin reaction determines which allergens are factors in your dog’s atopy.

Once the culprit allergens are identified, a specific serum mixture is formulated for your pet.  Injections  or sublingual (under the tongue) allergen solutions are given in increasingly larger doses to build your pet’s immunity to these allergens, a process known as hyposensitization.  The overall success rate for this type of immunotherapy is about 70-85% with pollen allergies often responding best.   Results may take 4 to 14 months to be seen, so this therapy requires long-term commitment.

If allergy testing and hyposensitization injections are not an option, there are other therapies available for atopy.  Since skin exposure is the most important route, topical therapy is extremely important for a successful outcome.  Routine bathing with a hypoallergenic or veterinarian-recommended medicated shampoo at least once weekly should be done.  In addition, wiping your pet’s feet and underside with a damp cloth or baby wipes after coming in from outside will decrease the allergen load.

Corticosteroids have long been a mainstay in the treatment of atopy.  They can be a valuable addition to the therapeutic regimen when used in appropriate doses, forms and lengths of time.  However, the side effects associated with corticosteroids are numerous.  A medication called Atopica is the first FDA-approved oral medication specifically developed to control canine atopy.  It contains no steroids so may be a better option for long-term use, but it does not have the rapid effectiveness of corticosteroids.

Perhaps the most exciting development in canine allergy control is a medication called Apoquel.  Apoquel is a new class of drug that works by blocking the itch associated with allergies at its source.  It starts to control itchiness quickly (within 4 hours) and does not have the steroid-associated side effects.  It is also safe to give with other medications, labeled for long term use and is very well tolerated.  In fact, I have one of my own dogs (Bubba) on it year-round and have been amazed by its effectiveness.  By controlling Bubba’s itchiness and inflammation, Apoquel has virtually eliminated the hot spots and skin infections that he used to develop during peak allergy season.

Remember that allergies are never cured, only managed.  And a pet with allergies often suffers from more than one type.  So it is important to use a combination of therapies that provides the best control with the fewest risks of a negative health impact.  You must also realize that therapy is life-long.  There is no “quick-fix”, but with the guidance of your veterinarian you can help your pet have a comfortable, (almost) itch-free life.

We are getting a new puppy and are really worried about how to get her house trained. I remember my parents using a rolled up newspaper to correct my childhood dog, but know that is not an appropriate way to train! Any potty training tips?  -Marie, Beaumont, TX

Congratulations on your new puppy! House training can definitely be a daunting task, but with attention and consistency you will soon be headed toward potty time bliss.

Select a site outdoors that you want to be used for elimination purposes. It is important to focus on where you want your puppy TO go, as opposed where she is not supposed to go.  Puppies may more easily learn if a single potty spot is chosen.

Knowing when puppies are most likely to eliminate is another key step to successful training. The urge to eliminate is strongest after eating, drinking, upon waking up and after playing. So take your puppy to the selected potty area within 30 minutes of any of these activities.

In addition, most puppies must eliminate at least every 3-4 hours, especially during the daytime. Not taking your puppy out frequently enough or at the right times is a common cause for training delays.

When you take your puppy to the chosen potty area, give her a short, encouraging command such as “Go potty” or “Get busy”. As soon as elimination occurs, lavish her with praise and attention. A small treat may also be given.

The timing of the reward is important . Be sure it is immediately after elimination and not when you go back inside to avoid confusion about why they are being rewarded. I made that mistake years ago with my first dog. She would bark to go outside, then turn right back around to come inside for her treat!

You should take your puppy out on a short leash and, except for the potty command, stand still and ignore her until the transaction occurs. If she has not gone in 5 minutes, bring her back inside with no attention, but strict supervision until you can try again.

Your purpose is for her to understand that with no toileting there is no reward.  Some puppies learn that they can play, run, sniff and have a great time outside until they go potty, but then the fun stops and they must go back inside once they eliminate.  So they hold it until they are back in the “boring” house and then they go.

When your puppy is indoors, she must be strictly supervised so you can see when she has to go potty and take her outside to her elimination area. Cues for which to watch include circling, squatting, sneaking away, or heading to the door.  If these signs are noted, you should immediately take your puppy to her potty spot.

One of the best ways to keep your puppy supervised is to tether train – attach a leash to your belt and to your puppy. Then she will not be able to sneak away and have an accident and you can pay attention to her cues. When not able to supervise your puppy, a confinement area such as a crate should be used.

If an accident does occur, there is absolutely no point in punishing your puppy. Puppies cannot correlate a mess on the floor with knowing they should have toileted outside. In fact, they may even learn to fear eliminating in front of you (indoors AND outdoors) due to the threat of punishment.

Maybe a rolled up newspaper should be used – to thump you in the head for not paying close enough attention! Move the puppy to another room and quietly clean up the mess, vowing to supervise more closely in the future.

By taking your puppy outdoors on a regular basis to her potty area and providing appropriate encouragement and praise for success, you should be well on your way to a housetrained puppy and a pee-free house.