The Veterinarians' Guide to Your Cat's Symptoms - Michael S. Garvey, Anne E. Hohenhaus (1999)
Part II. A Sick or Injured Cat
Accidents Medical Emergencies
Most emergency situations involving cats are usually due either to accidental injury or to illness. Emergencies due to accidental injury may include trauma,such as a bad fall, hard blow, or being hit by a moving vehicle. In these cases a cat may suffer from fractures, concussion, or other internal injuries. Lacerations and woundsran be emergency situations if there is a lot of blood loss, and bite wounds from other cats can cause abscesses and serious infections such as pyothorax. It is an emergency situation if a cat eats a poisoned rat or mouse or ingests a harmful household substance such as antifreeze, human medication, or some poisonous plants. Because of their propensity to play with string or thread, both kittens and cats often swallow this type of material and these “linear” foreign bodies can obstruct and/or cut through a cat’s intestines. A cat can be accidentally burned, electrocuted, or suffer from smoke inhalation;in rare cases, cats can also drown. An illness may be an emergency if it is sudden andacute, or an ongoing illness can become an emergency for many reasons.
An important thing for a cat owner to bear in mind is that no matter how smart a kitten or cat may be, he has no concept of potential danger, especially if he has lived in a protected environment all of his life. It is up to an owner to think for her pet and try to make sure he is protected from dangerous situations as far as is possible.
When an owner is aware of the types of accidental emergency situations a kitten or cat can get himself into, she can use her common sense to take steps to avoid them. By anticipating danger for a kitten or cat, just as she would for a human toddler, an owner can prevent many emergency situations from arising.
One of the best things an owner of a new kitten (or even an adult cat that is new to the household) can do to protect a pet from accidental injury in the home is to take time to carefully examine the space the kitten will be living in, from the animal’s point of view, and remove any potential hazards.
For the first few days, many owners find it is best to confine a new kitten or cat to one room so he can become used to the household and its other residents gradually. A frightened new kitten may prefer a safe dark space at first, so any room where he can find a nice big piece of furniture to get underneath may suit him best. Food and water dishes and a litter pan should be placed nearby. As soon as the kitten begins to emerge from his hiding place and make friends with the humans in the household, it is usually safe to allow him the run of the house.
In general, kittens do not seem to suffer from much discomfort from teething, but they may still chew on things, especially dangling cords or wires. If a kitten chews on a plugged-in electric wire, he can easily be electrocuted, so it is safest to unplug electric wires when no one is around to watch a kitten, at least until an owner is sure the kitten will not chew on them.
As we mentioned above, almost all kittens and cats are intrigued by anything long and thin such as string, thread, or yarn (tinsel is especially tempting at Christmastime, and can be lethal). A thorough search should be made of the house before a kitten or cat is allowed complete freedom, to be sure all such objects are securely put away in a drawer or behind a closed door. Remember, it is not enough to put them up on a high surface or cubbyhole—cats can jump high and are able to squeeze into small spaces.
Because cats cannot be confined with a fence to a yard or run, the only way to avoid the possible trauma from their being hit by a car, motorcycle, or bicycle is to keep them indoors or teach them to walk with a harness and leash. As we mentioned in Chapter 2, indoor-only cats not only lead full and happy lives, but almost always live longer than their roaming cousins.
When riding in a car, a cat should always be in a sturdy carrying case so he cannot jump out of a suddenly opened door or window (see Chapter 2, for a discussion of types of carrying cases). When secured with a seat belt, a carrying case may help prevent serious injury in case of a car accident.
Outdoor cats are often injured by cars in adifferent fashion. On a cold night a cat will sometimes get underneath a car hood to sleep on top of the warm engine. When the engine is started in the morning, the cat can be severely injured by the fan and engine belts.
Kittens and cats are especially prone to traumatic injury due to falls from windows. Known as the “high-rise syndrome,” this can occur in the country or suburbs as well as a city apartment. A fall from a second-story window onto a flagstone path or tiled terrace can be just as damaging as one from a fourth-floor apartment window. Cats and kittens are particularly apt to become fascinated with an insect or bird flying by and forget where they are. Neither kittens nor grown cats should ever be left alone in an upstairs room with open, unscreened windows. Window bars do little to deter a cat, by the way, as most cats can squeeze right through them.
A study of the records of “high-rise” cats admitted to the Bobst Hospital of The Animal Medical Center in New York City revealed some very interesting facts about falling cats. The most serious injuries and the highest mortality rates occurred in cats who fell between five and nine floors. Cats who fell four floors or less and cats who fell ten or more floors had less serious injuries. Cats falling from lower floors are not falling as fast as cats falling from greater than five floors. After five floors, it is predictable that a falling cat has reached terminal velocity—that is, there will be no further increase in speed no matter how great the distance. It appears that cats falling from ten floors or greater have time to right themselves and fall in a position similar to parachutists in free fall, with the legs spread out to the side and the body parallel to the ground. When a cat hits the ground in this position, much of the shock is absorbed by his flexible rib cage and abdomen. The most serious injury in “highrise” cats is pneumothorax (collapsed lungs with free air in the chest cavity). This is an emergency; the air must be removed by a veterinarian to allow the lungs to re-expand. But it is very possible to save a cat who has fallen great distances. Two cats who survived in New York City fell thirty-two and forty-six floors.
Kittens’curiosity can also get them into trouble if they dart, unseen, into open closets, bureau drawers, and other spaces where they can become trapped. Refrigerators and clothes dryers are also hazardous; young kittens, especially, often climb into them and can suffocate or be killed if they are not discovered. Some adult cats never outgrow the tendency to get into small spaces; not only should owners be aware of this, but anycaretakers should be told always to check to see where a cat is before turning on the dryer or leaving the house.
Cats are not as subject to accidental poisoning as dogs because they are apt to be more choosy about what they eat. But there are exceptions. Kittens’curiosity may lead them to sample something an adult cat would not, so owners should be especially careful to keep any harmful substances out of their reach. Again, it is important to remember cat’s ability to reach things, so any potentially poisonous substances should not only be put away, but must be securely closed.
Many common household chemicals are poisonous to cats as well as humans, but most do not appeal to cats because of their foul smell or taste. An exception to this is antifreeze, which has a sweetish taste that is irresistible to cats. Antifreeze contains ethylene glycol, a highly toxic chemical fatal to cats. Antifreeze should be kept in tightly closed containers, and extreme care needs to be taken that no radiator fluid containing antifreeze has leaked onto a driveway or garage floor. This is especially important for an indoor-outdoor cat, but even an indoor-only cat may venture into an attached garage. A cat that is suspected of ingesting antifreeze needs immediate veterinary care to prevent kidney failure and eventual death. A safer antifreeze made with propylene glycol is now available commercially. Pet owners may want to consider using it as an alternative.
Rat poison is another insidious danger for cats. Although they are not apt to eat the poison itself, they can be poisoned if they catch and bite or eat a poisoned mouse or rat. Rat poisons contain a substance called warfarin, or similar chemicals, that interferes with a cat’s blood-clotting ability and blocks the production of vitamin K. A cat that has ingested rat poison may become anemic, have trouble breathing, suffer from nosebleeds, internal bleeding, and bruising. Prompt treatment with vitamin K injections and blood transfusions will usually help.
Cats are particularly sensitive to medications and can suffer from drug intoxication if they eat or drink human medications, especially those containing acetaminophen. A cat who has ingested acetaminophen doses as small as a simple pill may develop methemoglobinemia, a condition in which blood hemoglobin is changed so that it doesn’t carry oxygen. Poisoned cats will exhibit difficult breathing, dark blue tongue and mucous membranes, and a swollen face. Immediate treatment is necessary to prevent fatality. No medication is safe to give to a cat without veterinary supervision.
Cats often play with, and chew, houseplants and will play with fallen berries and leaves. However, plant poisoning is usually not a serious problem because the bitter or foul taste of most plants prevents a cat from ingesting a great deal. The greatest problem can be a potentially dangerous swelling of the mucous membranes of a cat’s mouth and throat. Dieffenbachia, or dumbcane, contains a particularly large amount of a substance that can cause swelling of the mucous membranes, and mistletoe and holly berries can make a cat quite sick if he eats enough of them. Japanese yew can be fatal to cats and members of the lily family can cause kidney failure.
If a kitten or cat is known to have eaten anything potentially poisonous, an owner should immediately call a veterinarian. If a veterinarian cannot be reached, call the ASPCA National Animal Poison Control Center at 1-800-548-2423.This center is manned by veterinarians and board-certified toxicologists and is open twenty-four hours a day, every day. A $30 consultation fee is payable by credit card. If possible, an owner should have information available about the substance ingested. Immediate action can often prevent permanent health damage and even death.
For free nonemergency information about pesticides concerning both animals and people, call The National Pesticide Telecommunications Network (NPTN) at 1-800-858-7378. At this number, graduate scientists will answer inquiries about lawn-care and gardening products, pestcontrol products, and so forth, as they might affect both pets and people. This service, available from 6:30 A.M. to 4:30 P.M., Pacific time, seven days a week, excluding holidays, is a cooperative effort of Oregon State University and the U.S. Environmental Protection Agency. See also “Drug Poisoning/Intoxication”, and Appendix A.
The most frequent reason a cat suffers from heat prostration is because he is left in a carrying case in a parked car during warm weather. On a sunny day when the temperature is in the seventies, it takes only a few minutes of sunshine on the car for the interior to heat up to over a hundred degrees, even if the windows are partially open. The poor ventilation in a carrying case combined with the heat in the car leads to heat prostration, which develops very quickly in cats because of their small size and inefficient means of cooling their bodies. The only way cats have to cool themselves down is by panting to allow moisture to evaporate from their mouths.
A cat may also suffer from heat prostration if he is closed in a small, hot, poorly ventilated room. Brachycephalic cats are especially prone to heat prostration because of the malformation of their faces and noses.
If a cat does appear to have difficulty breathing, or collapses from the heat, he must be rushed to a veterinarian immediately in order to save his life. More about heat prostration.
Some Feline Medical Emergencies
As we said above, an ongoing illness can develop into an emergency for various reasons. A severe medical problem that occurs suddenly is also an emergency situation. Following are some commonly occurring feline medical emergencies. In most instances there are no effective home first aid steps that can or should be taken, and prompt veterinary care is necessary.
BLOODY DIARRHEA OR STOOL
When a cat is passing normal stools or diarrhea containing streaks or flecks of blood, it is not a severe emergency. If, however, a cat passes a lot of blood rectally, veterinary attention should be sought immediately. There is no first aid for serious blood loss in the stool.
BLOOD IN THE URINE
Bloody urine is usually a sign of a urinary tract infection such as bacterial cystitis, and is not a serious emergency. If the urine is very dark or blood clots are passed, it is a sign of profuse bleeding, which requires immediate veterinary attention. There is no first aid for serious blood loss in the urine.
If fluid is being vomited, vomiting is infrequent, or there are only flecks or streaks of blood in the vomitus, it is not a serious emergency. If, however, there is a profuse amount of blood thrown up or if there are blood clots present, it can indicate serious bleeding in a cat’s stomach. There is no first aid for this condition and immediate veterinary help is necessary. Oral medication should not be given if a cat is vomiting blood.
SPONTANEOUS BRUISING, NOSE BLEEDS
Bruising can be difficult for an owner to recognize because of a cat’s haircoat. If there are purple splotches on a cat’s stomach it can be a sign of a clotting disorder. Bleeding from the nose can also be very serious and can occur from a clotting disorder, possibly from rat poison. Small purple or red spots on the insides of a cat’s ears or on his gums may indicate a low platelet count, or some other type of bleeding disorder. A cat can bleed into internal cavities, such as the chest, or abdomen, which can cause severe problems. Bruising of any sort should be considered serious and veterinary care sought.
If a cat has difficulty breathing he may be suffering from feline bronchial asthma, a condition very similar to human asthma. This can be the result of an allergic reaction to some airborne pollen, dust from the environment or cat litter, and so forth. It can be a serious or life-threatening emergency and veterinary care should begin immediately. Asthma in cats can be controlled but never cured completely. Cats with asthma usually have a history of coughing, so owners should pay attention to this rather uncommon symptom in cats.
Whenever a cat is having difficulty breathing it should be considered a severe emergency. Breathing difficulty can be caused by cardiomyopathy(see below), feline infectious peritonitis (FIP —), pneumonia (see below), or a serious chest injury that produces pneumothorax. If a cat has had a serious chest injury such as a fall, being hit by a car, or an invasive chest wound, he will have great difficulty breathing and may have bluish mucous membranes (cyanosis) as well. This is a severe emergency that requires immediate veterinary help. Cyanosis is a sign of insufficient oxygen.
Cats do not suffer from cholesterol problems or heart attacks as people do. The most commonly seen feline heart disease is disease of the heart muscle and can take several forms. A cat can have cardiomyopathy for years before symptoms surface. Hypertrophic cardiomyopathy (HCM) causes the heart to fail suddenly. A cat will develop fluid in his lungs (pulmonary edema) and will have difficulty breathing. Dilated (congestive) cardiomyopathy often creates a buildup of fluid in a cat’s chest cavity outside his lungs, causing the lungs to collapse. Cats with heart failure will be very quiet, reluctant to move, and may exhibit difficulty breathing. These cats require immediate veterinary help.
Collapse, or unconsciousness, can be due to a number of conditions that are described in this chapter such as: shock following a traumatic injury; an ongoing systemic or metabolic disease; severe blood loss; difficulty breathing; poisoning; anemia; or seizures. In some cases, a cat may even lose consciousness. In all cases, a cat that has collapsed or become unconscious must be evaluated by a veterinarian right away.
Cats do not suffer from diarrhea as frequently as dogs do. If a cat has an occasional bout of diarrhea it is usually not serious and may be the result of injudicious eating of prey, for instance. Exceptions are bloody diarrhea (see above), if it lasts for longer than twenty-four hours, and/or if the diarrhea is accompanied by vomiting or other symptoms of illness such as fever, loss of appetite, and signs of pain or illness. Then it may be a sign of poisoning, or a systemic illness or infection.
Hypoglycemia, or low blood sugar, usually occurs in cats that are undergoing insulin treatment for diabetes mellitus (see Glossary), and is characterized by several different signs. A cat with this condition may be weak and confused. He may not respond to his name, and pace and wander aimlessly If hypoglycemia is allowed to go on for too long, seizures and eventually coma will follow.
A cat with hypoglycemia may have an acute onset of seizures or convulsions. During a seizure a cat will roll over on his side, make rapid jaw movements, salivate profusely, let go of bowel and bladder, and shake his limbs violently.
With hypoglycemia, first aid treatment may help. Honey, syrup, or sugar water may reverse the problem for a cat that begins to become confused or weak, but only if it is given at the first sign of a problem, before seizures or collapse occur. Approximately one tablespoon of something containing sugar should be spooned or dropped into a cat’s mouth, a little at a time. Do not try to give anything orally if the cat is unconscious! Even with proper treatment there may sometimes be brain damage. A veterinary checkup should be given once the cat is stabilized. Kittens who are not eating may also become hypoglycemic. Never allow a small kitten to be fasted for a prolonged period.
Unlike with other animals, pneumonia can occur in cats without any preceding symptoms such as coughing. The first signs of pneumonia in a cat can be severe, life-threatening, labored breathing, collapse, and bluish mucous membranes (cyanosis). This is an emergency condition requiring immediate veterinary help.
Pyometra is a surgical emergency that occurs in older, unspayed, female cats. It is an infection of the uterus and has variable signs and symptoms. Some cats may show only a gradually enlarging abdomen, while others may also show signs of systemic illness, including anorexia, fever, depression, vomiting, or diarrhea. Surgical removal of the uterus is the only treatment.
This is a condition arising from a raging infection in a cat’s chest cavity. A cat withpyothorax is extremely sick and probably is running a fever. Because of fluid in the chest cavity, he will have severe difficulty breathing (dyspnea) and will be very depressed.
The infection is caused by either a penetrating wound or a systemic spreading of bacteria in a cat’s bloodstream due to a simple bite or puncture wound. This is a life-threatening condition and requires immediate veterinary intervention.
Seizures are not as common in cats as they are in dogs, but they can occur and are usually brought about by a medical condition such as hypoglycemia (see above), or an inflammatory disease of the brain. Idiopathic (no known cause) epilepsy is also possible.
If a seizure is short and the cat then returns to normal it is not a serious emergency. However, if a cat has several continuous seizures that last a long time (status epilecticus), or is having multiple seizures (sequence clustering) he may die or have permanent brain damage due to hypoxia (loss of oxygen to the tissues). Hospitalization and intravenous administration of various anticonvulsants are necessary—this is an extremely serious condition. An owner’s detailed history of the onset of seizures is invaluable to a veterinarian in making a diagnosis and decision about how to treat the underlying cause of a seizure.
A cat that is straining to urinate may be suffering from feline lower urinary tract disease (FLUTD, formerly known as FUS). Other signs of this disease may be frequent licking of the genital region, bloody urine, and urinating outside the litter pan. Some cats show no initial symptoms of FLUTD and simply become very ill. If the urethra becomes obstructed the cat will be in obvious pain, may vomit and lose his appetite, and will show signs of straining to urinate. Male cats are affected more often than females. If it is not treated promptly, the condition may lead to a dangerous level of potassium elevation in a cat’s body, which can cause heart problems and death.
The cause of FLUTD in cats is still being debated. It does not appear to be caused by an infection and may be related to a dietary mineral imbalance, urine too high in pH (alkaline urine), and/or some inherent predisposing factor. There are prescription diets on the market that can help prevent recurrences of this problem. Sometimes a surgical procedure called a perineal urethrostomy to shorten, straighten, and widen a male cat’s urethra is necessary to stop the problem.
All cats vomit occasionally and some vomit two or three times a week without signs of illness.
If a cat vomits but seems to feel well otherwise it is usually not an emergency. If the vomiting is preceded by retching and the resulting vomitus is tubelike and contains hair, it is a hair ball and can be safely ignored (for steps to help prevent hair balls). If, however, there is a lot of blood in the vomitus (see “Vomiting Blood,” above), if it persists for more than twenty-four hours or is accompanied by diarrhea, fever, abdominal distension, obvious discomfort or pain, weakness, loss of appetite, or listlessness, it may be a symptom of a number of different conditions. Veterinary help should be sought right away in any of these cases. If a cat vomits frequently and is losing weight, the problem should also be investigated.
Accidental Feline Emergencies
In general, the best treatment an owner can provide for a cat suffering from an accidental injury is to get him to a veterinarian right away. It is foolish and dangerous to waste precious time trying to give emergency first aid, and often whatever measures are taken won’t help and may harm a cat. If there are appropriate first aid steps, they are included here.
Because a cat’s blood volume makes up only about 6 percent of his total body weight, blood loss is of particular concern in cats. Bleeding or hemorrhaging from any part of a cat’s body is an emergency whether it is acute, profuse bleeding, or chronic, continuous blood loss. The best way to determine if the bleeding is serious is to check for signs of shock (see above) or anemia.
Bleeding from the Nose or Mouth
This can be life-threatening if bleeding is profuse. Cold compresses or ice packs can slow the bleeding but are very difficult to apply. Emergency veterinary treatment should be sought immediately.
Bleeding from the Skin
Cuts or wounds on a cat’s skin surface will cause some bleeding although it is usually not severe. If a wound is deep it can puncture a vein or blood vessel beneath the skin surface and bleeding will be more profuse. This is most likely to happen in cats if the wound is in the neck orleg area (see below). Apply pressure by hand to slow the bleeding using a clean cloth or bandage (see illustration, below). If the area can be bandaged, a compression bandage should be used (see illustration, below).
Foot and Leg Bleeding
Cats walk lightly and do not often cut their feet. But if they do, lacerations of the footpads bleed a great deal. Cat’s footpads consist of spongy tissue and even after bleeding has stopped, cuts often bleed again as soon as a cat steps on his foot. To prevent continuous blood loss from a footpad laceration, a pressure bandage should be used.
More serious, spurting arterial bleeding can occur if a cat cuts the small artery that runs up the leg right behind the footpads. This is not a common injury in cats, but it can occur if a cat is caught and bitten by a dog, for instance, or is hit by a moving vehicle. This type of bleeding should be stopped with a pressure bandage placed around the entire foot and lower leg. The use of tourniquets is not advised. They can easily cause the loss of a limb due to inadequate blood supply and do not stop bleeding as well as pressure.
A cat can break any one of the hundreds of bones in his body. A cat with a suspected fracture should be kept quiet, treated for shock (see above), and moved as little as possible. Pick the cat up by his chest or stomach and place him in a carrying case, carton, or even a clean litter tray, and take him to the veterinarian (see page 17). Splints or other means of immobilizing an injured limb usually cause more discomfort and pain to a cat than leaving it alone.
Cats are rarely burned with fire, but they can fall into a tub of scalding water. More often, they can be burned when scalding water or hot grease falls on them. This can cause diffuse burns that can be extremely serious. No first aid is recommended, but prompt medical treatment is necessary.
Cats should never be given any medication without a veterinarian’s advice. Even drugs that are generally considered safe for other species, such as aspirin, acetaminophen, tranquilizers, and so forth can cause serious problems in cats. Cats are not apt to swallow anything unfamiliar, but if a cat should swallow any human medications or drugs such as marijuana, hashish, or hallucino-genics, it is an emergency. If an owner is sure a cat has ingested medicine or other drugs that are not caustic, she should get the material out of the cat quickly by inducing vomiting. Hydrogen peroxide given orally with a spoon will cause a cat to vomit and will not harm him. The cat should be seen by a veterinarian right away to be sure no drug remains in his body and to check for any side effects. See also Appendix A, page 145.
Kittens, which may chew electric wires, are much more apt to suffer from electrocution than adult cats. Electrocution may be mild and there may be very few signs, but it usually results in shock and significant pulmonary edema (fluid in the lungs), causing labored, difficult breathing (dyspnea). Cyanosis (blue mucous membranes) may be present, as may shock (see above). A kitten must be treated right away with diuretics and oxygen to save his life. If an owner comes home and finds a kitten lying on his side unable to move and having difficulty breathing, she should suspect electrocution. This is true even if visible burns are not obvious in the mouth or on the tongue.
Cats’ eyes are often injured in fights with other cats. Any eye injury must be treated quickly and appropriately to prevent permanent damage. No first aid, such as putting water on the eye, should be attempted as it will upset the delicate eye membranes and will do more harm than good.
We spoke about heat prostration earlier in this chapter. Any cat that regularly has difficulty breathing such as an extremely brachycephalic cat, one that is severely overweight, or a cat with a heart problem will be at greater risk from heat prostration if he becomes overheated or overexerts.
If a cat is suffering from heat prostration he will breathe noisily with his tongue hanging out and may have thick foam and saliva in his mouth. His body temperature will be very high and he may be in shock (see “Shock,” page 5 5). It is imperative to quickly cool a cat that is suffering from heat prostration. It is all right to try to cool a cat by misting him all over with a spray bottle, but it is best to rush him to the veterinarian as quickly as possible so that he can be cooled and receive medication to prevent brain damage from the heat and hypoxia (deficiency of oxygen). If the cat has blue mucous membranes, there may be an airway obstruction from thick saliva in the back of his throat. If an owner can safely open the cat’s mouth and clear the saliva with a paper towel or gauze square, it may save the cat’s life. The leading cause of death from heat prostration is cardiovascular collapse, shock, and a condition known as DIC, a bleeding disorder caused by prolonged excess body heat. DIC often starts with bleeding from the nose and progresses to profuse hemorrhaging. Once it has begun, there is usually nothing that can be done to save the cat.