Minoxidil : A Baldness Treatment

Minoxidil has become extremely popular due to its ability to stimulate hair regrowth on the scalp of people. It was originally marketed as Rogaine, but is now available as an over the counter generic in liquid, foam and shampoo forms.

When cats lick even a tiny amount, it causes vomiting, drooling, low blood pressure, severe illness and often death. Because the product is applied to the skin, it can easily come into contact with cats either directly, by licking the area, or even from pillows.

I first discovered this toxin one year ago after a report from the Animal Poison Control Center that you can read here. In their list of the top causes of poisoning deaths in cats, it included a drug I had never heard of.

If I didn’t know about it, it meant many other vets didn’t either, and very few cat owners.

The message is simple: if you use minoxidil in any form, be extremely careful:

• Clean up areas carefully after use, especially spills or stray drops
• Do not allow your cat to come into contact with treated areas of skin
• Prevent access to bedrooms 
• Clean sheets and pillowcases frequently

PPD: A Hair Dye Ingredient

Para-phenylenediamine (PPD) is a fixative found in many hair dyes and henna temporary tattoos. It causes a deeper, longer lasting and more intense colour. Oral ingestion leads to intravascular hemolysis, rhabdomyolysis, myoglobinuria and acute renal failure. 

In other words, this means massive destruction of red blood cells and muscle cells. The release of their contents into the circulation causes downstream kidney damage. This is the same process you sometimes hear about with overexercise in hot conditions. 

I only heard about this toxin last week, but I saw a case a year ago that I’m now convinced was caused by it. 

Mimi’s Acute Renal Injury

Mimi’s owners came to me for a second opinion after he was diagnosed with acute kidney failure. The interesting thing is that despite an extensive search for the toxin, it was never found. However, due to the timing, Mimi‘s owners strongly suspected that a hair dye had caused it.

At the time, I conducted a search to the best of my abilities and found no link between dyes and poisoning. The case remained a mystery. Mimi survived only thanks to heroic efforts by his owners and a number of veterinary teams.

Knowledge of the toxicity of PPD is well known in human medical circles, but no documented cases of poisoning exist in animals. It’s likely that the lack of evidence is due to a lack of recognition, not occurrence. Like in Mimi’s case, it’s near impossible to prove a particular toxin causes kidney failure due to the delay between poisoning and diagnosis.

Once again, prevention is about minimising exposure:

• Use hair dyes and hennas without PPD if possible
• Use dyes and hennas in a well-ventilated place where your cat cannot join you
• After completion, clean up any spills and splashes carefully
• Rinse basins, baths and showers thoroughly since cats often like to lick these areas after use
• Don’t allow your cat to lick the dyed areas

Diclofenac (Voltaren)

A third common cause of cat poisoning deaths is the human use of potent anti-inflammatories. Once again, the risk is mainly from products applied to the skin. Products like Voltaren gel contain diclofenac, which even in small quantities will cause kidney failure.

Cats are likely to be poisoned either by licking the treated areas, or getting spilt product on their paws or coat. In addition to the methods above, prevention should also include covering the treated areas with clothing and keeping the products in a secure place.

The Common Link

All three of these toxins show us how susceptible cats are to household poisoning. This is for three reasons:

1. Cats are naturally inquisitive and will seek out and investigate new things
2. Cat seem inherently sensitive to a wide range of chemicals
3. Anything that contacts the outside of a cat will invariably be licked off and swallowed

The third point means we should add a final form of prevention: if anything not known to be safe gets on your cat’s coat or paws, you will need to give them a bath. This is not a decision taken lightly, but it may be life-saving.

Moreover, I would be careful about any medicines, dyes or other household chemicals, regardless of whether they contain diclofenac, minoxidil or PPD*. If we are learning one thing, it’s that cats will show us just how toxic a chemical can be.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Sources

Anuradha, S., Arora, S., Mehrotra, S., Arora, A., & Kar, P. (2004). Acute renal failure following para‐phenylenediamine (PPD) poisoning: a case report and review. Renal failure, 26(3), 329-332

Tater, K. C., Gwaltney-Brant, S., & Wismer, T. (2021). Topical Minoxidil Exposures and Toxicoses in Dogs and Cats: 211 Cases (2001–2019). Journal of the American Animal Hospital Association, 57(5), 225-231

* Just look at the ingredient list for a non-PPD containing hair dye for example: how many of these do you think have been tested in cats? Cetearyl Alcohol, Ammonium Hydroxide, Glyceryl Stearate, Ceteareth-20, Toluene-2,5-Diamine Sulfate, Octyldodecanol, Sodium Laureth Sulfate, Ethanolamine, Sodium Cetearyl Sulfate, Fragrance, 2-Methylresorcinol, Resorcinol, Serine, Sodium Sulfite, Oleic Acid, Potassium Stearate, Glycerin, Tetrasodium EDTA, m-Aminophenol, Carbomer, Linalool, Potassium Hydroxide, Citronellol, Ascorbic Acid, Butylphenyl Methylpropional, Linoleamidopropyl PG-Dimonium Chloride Phosphate, Propylene Glycol, Sodium Sulfate, Hexyl Salicylate, 2-Amino-3-Hydroxypyridine, Hydrogen Peroxide, PEG-40 Castor Oil, Disodium Pyrophosphate, Disodium EDTA, Sodium Benzoate, Phosphoric Acid, Behentrimonium Chloride, Dimethicone, Amodimethicone/Morpholinomethyl Silsesquioxane Copolymer, Magnesium Citrate, Magnesium Chloride, Hydrolyzed Keratin, Polyquaternium-37, Macadamia Ternifolia Seed Oil, Panthenol, Isopropyl Myristate, Citric Acid, Phenoxyethanol, Stearamidopropyl Dimethylamine, Isopropyl Alcohol, Sodium Methylparaben, Dicaprylyl Carbonate, Laureth-23, Laureth-4, Sodium Hydroxide, Hexyl Cinnamal, Benzyl Salicylate, Benzyl Alcohol, Limonene, Lauryl Glucoside, Trideceth-5, Salicylic Acid.

When there’s a lack of hard evidence, we only have experience to go by. So I’ll use mine to help you answer the key questions put to me by cat owners.

What Is A Hairball?

A hairball, or more technically a trichobezoar, is a hard pellet of matted hair found in the gastrointestinal tract. They occur due to hair being swallowed during the normal grooming process, which then accumulates in the stomach.

Eventually the hairball gets to a size where it is vomited up. Such an example is pictured here, surrounded by food. A hairball is much more rarely passed in the faeces.

It’s difficult to know if hairballs are normal or abnormal. My view is that they are an inevitable consequence of grooming. Our task is to prevent them from causing problems.

Help! My Cat Just Vomited A Hairball!

If a cat vomits up hairballs frequently, you need to consider four possibilities:

1. That the hairball is a normal accumulation of hair vomited up at the right time
2. That the hairball is caused by health problems
3. That the hairball is causing health problems
4. That your cat is vomiting for another reason, and with it comes the resident hairball

In my experience, point 4 (the hairball as an innocent bystander) accounts for most of the cases I see. To help you recognise it, let’s go through the other three possibilities.

1. How Often Do Cats Throw Up Hairballs?

A cat passing hairballs normally will:

• Vomit no more than weekly
• Have a single rapid effortless vomit, and be immediately hungry afterwards
• Have no other health problems

2. When Hairballs Are Secondary To Illness

Underlying health problems that could lead to hairball problems are mainly of the skin or gastrointestinal tract.

Skin problems mostly relate to what we call overgrooming. Historically, this has been labelled a psychological problem, but the more we know the more we understand it’s usually a response to itchy skin. If your cat’s coat does not look healthy, click here for a deep dive into the causes of overgrooming in cats.

Gastrointestinal problems are a mixed bag, ranging from parasites to allergies to food responsive disease. Again, if your cat vomits more frequently, is underweight or has loose stools, click here for a discussion of the possible causes.

3. How To Know If A Cat Has A Hairball Stuck

A cat with a hairball large enough to cause problems will usually only have the following symptoms:

• Frequent unproductive vomiting
• Poor or no appetite

However, these signs are vague and caused much more often by other serious conditions.

Therefore, unless your vet can feel a lump in your cat’s belly, they need to consider all the causes of vomiting in cats, plus those of not eating. And given how often people confuse coughing and vomiting in cats, don’t rule this out either

A clue that looking for a hairball might be a good idea can come from the patient’s history. These cats are more likely to:

• have a history of hairball problems
• have a highly shedding coat like the one above
• have a long coat
• be an older cat

4. When Hairballs Aren’t The Cause

Vomiting is probably the number one sign of a sick cat, and has hundreds of possible causes. Many of these cats will have identical risk factors to those prone to hairballs, just to make it harder.

Most of the cats I see who are brought to me for a hairball problem actually have a vomiting problem. Probably top of the list is pancreatitis because it’s so hard to diagnose. It’s just that there’s often a hairball in their stomach when they vomit.

Therefore, there’s no good alternative to a thorough workup, usually via blood testing and ultrasound examination to begin. Only once we draw a blank might we be prepared to blame the hairball itself.

How to Help A Cat Pass A Hairball

If a cat’s problems are caused by a hairball, you can try to help it pass. Don’t do this unless you’re absolutely sure, as you will waste valuable time.

Please note that cats do not commonly pass hairballs in their litter tray. I am personally dubious that cat laxatives like the one pictured here actually do very much. However, if your cat is bright, happy and eating, there’s probably no harm in trying.

Just follow the instructions on the package. I am not aware of any other remedy that might work. However, these products are most useful for prevention anyway.

How To Prevent Hairballs In Cats

Unlike the unreliability of treating a hairball, there are effective ways to prevent them forming.

The first is to remove as much dead hair as possible before your cat does. This will require daily brushing with a slicker brush or similar. If you started while your cat was a kitten, they will usually enjoy it.

It’s messy. I had a cat like this once, and I kept an old theatre gown near my armchair to protect my clothes.

The second is diet. Royal Canin, Hills and no doubt others make effective hairball preventing diets. They work by removing the hair from the stomach before it balls up. Most use either cellulose fibre or psyllium.

The third, of course, are hairball treatment products like pictured above.

Can A Hairball Kill A Cat?

I have seen two cats who would have died without their hairballs being surgically removed. That’s not many over 27 years but it does happen.

For these cats, their owners agreed that the risk was too high to ever let it happen again. Therefore, we took the nuclear option: clipping.

Every six months for life, these cats were booked in for a full shave under sedation. It kept them free of problems, even if they did look a bit strange.

But the main way a hairball can cause death is through inaction. This study contains one cat who died through a delay in treatment and another who was euthanased due to a mistaken belief it was a tumour. And there are also those cats where a much more serious vomiting or coughing problem is written off as ‘hairballs’.

I hope all this helps, no matter whether you have a minor or major problem. But in closing I’ll repeat: hairballs are more often suspected than actual culprits. Keep an open mind!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Note that this article is not about lumps on the skin of cats. Those need a checkup at the vet to know what they are.

Five cats were presented to a veterinary teaching hospital with abdominal masses that could be felt during a routine exam. They all had the classic signs of intestinal obstruction: vomiting, listlessness and not eating.

The two eldest cats died. One, because her owner thought it was cancer and had her put down. The other, due to a delay in treatment, most likely due to a similarly fatalistic attitude.

The diagnosis in these five cases was a hairball. A thoroughly treatable problem.

Types Of Stomach Lumps In Cats

Part of the problem here is a lack of good quality information. I can find no research paper which looks at how common different lumps of cats are. So this list is based on my experience alone.

Hairballs

There are sporadic reports in the literature of hairballs causing gastrointestinal obstructions, and I have seen them too. Risk factors might include:

• A long coat
• Skin and coat problems
• Poor health for another reason

It’s worth noting that the cat who was euthanased had none of these risk factors. And the big danger with a hairball is that it feels exactly the same as a tumour.

Visit this page to read about hairball treatment and prevention, but in only a few minutes you’ll know how to recognise one.

Feline Infectious Peritonitis

You can read about FIP in more detail here, but one of its forms causes abdominal masses or tummy lumps. Clues that lumps in the belly might be caused by this dry form of FIP are:

• a young cat
• a persistent fever
• a longer course of illness

Once again, these are only generalisations. I have seen FIP in older cats with no fever too.

Followers of this blog will know that there have been recent and exciting changes to how we treat FIP. What was once a death sentence is now survivable for the majority of cats. All the more reason to get that diagnosis.

Lymphoma

Lymphoma is a tumour of one of the cells of the immune system. This is probably the diagnosis we fear the most, because it’s mostly a death sentence. Attempts at treatment are often very disappointing.

It’s true that abdominal lymphoma is one of the most common cancers of cats but there’s no way you can be certain just by feeling it. And I only see a few cases a year, much less than I see FIP.

Other Abdominal Masses

Of course, the abdomen is a complex place, and so there are many other less likely causes of lumps in the belly. Here are just some:

• Tumours arising from any of the organs or tissues
• Foreign bodies like surgical swabs, grass seeds or swallowed string
• Enlarged kidneys from ureteral blockage secondary to stones

Diagnosis Of Abdominal Masses

There’s one test that should be able to distinguish between all these causes: ultrasound. It’s neither difficult, invasive nor terribly expensive.

• A hairball will show itself as a mass inside the stomach or intestine containing large amounts of gas
• FIP mostly causes many irregular masses in the mesentery between the intestines
• Lymphoma can be the same, or a single larger mass like pictured, and easily diagnosed by ultrasound-guided needle biopsy
• Enlarged kidneys, abscesses or other tumours are usually just as obvious

Some vets may prefer to do CT, MRI or even exploratory surgery. All of these are good, and a whole lot better than not trying at all.

Going back to that paper at the start, it’s important to look at who published it. Although they don’t say so, most or all of those cats were probably referred from other vets. Whenever I read this I always think: “great, but referral is only the tip of the iceberg”.

Many more cats could have had similar experiences at private veterinarians and we would never know. But against this very negative outlook is a very positive one.

20 years have passed since this study was published. In that time ultrasound has gone from a referral procedure to one that nearly every vet practice can do well.

Therefore, despite my warnings, I’m confident that we aren’t euthanasing many cats with hairballs any more. But it requires a positive attitude, too!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

The paper I mentioned was:
Barrs, V. R., Beatty, J. A., Tisdall, P. L. C., Hunt, G. B., Gunew, M., Nicoll, R. G., & Malik, R. (1999). Intestinal obstruction by trichobezoars in five cats. Journal of Feline Medicine and Surgery, 1(4), 199-207

Signs Of Oesophageal Stricture

Affected dogs and cats show the characteristic sign of being interested in food, but unable to keep it down. Critically, this is due to regurgitation. 

Recognising the difference between regurgitation and vomiting is very important for a quick diagnosis:

• Regurgitation is a passive flow of food or water without obvious effort. There can be a lot of white foam and it almost never contains yellow bile.
• Vomiting involves repeated abdominal muscle contractions, and usually takes longer. Bile or a strong acid smell is often present. 

Other signs of oesophageal stricture can be:

• Excessive salivation
• Difficulty eating or swallowing
• Weight loss
• Dehydration

What Causes Oesophageal Stricture?

The table shows a summary of 111 affected dogs and cats where the cause was reported. 

Any injury to the oesophageal wall can lead to scarring and narrowing of its internal diameter. The most important of these is gastro-oesophageal reflux. Under anaesthesia, stomach acids sometimes enter the oesophagus where they may cause severe burns. This can also happen during severe vomiting episodes.

Other injuries leading to stricture can be caused by foreign bodies (especially inappropriately fed bones), severe road trauma and caustic drugs. Doxycycline and clindamycin in particular are two commonly used tablets that must never be given without food. 

After the damage occurs, regurgitation can develop anytime within 3 weeks (typically 7 days). It’s essential to stress that while anaesthesia can cause it, oesophageal stricture is an extremely rare consequence (I have only seen it once, after an emergency surgery). 

Click here to read more about the prevention of oesophageal stricture after anaesthesia.

Treatment Of Oesophageal Stricture

The goal of treatment is to allow a dog or cat to eat and drink without requiring special care. Complete cure, defined as the ability to ingest food of any consistency, is only seen in 12%‐23% of cases but is not necessary for a good quality of life.

Once a stricture is diagnosed, immediate supportive treatment may be:

• Drug therapy to reduce ongoing oesophagitis
• Nutrition and hydration via placement of a feeding tube in cases of severe narrowing

If the patient is stable, attempts are made to widen the narrowing via mechanical dilation. There are currently two established methods:

1. Bougienage is the passing of solid tubes of increasing diameter to slowly stretch the stricture
2. Balloon dilation is the same approach using inflatable tubes of gradually increasing size

Whichever is chosen (mostly balloon these days), process is slow to avoid tearing the oesophageal wall, which can be fatal. Dogs and cats require an average of three treatments, but a positive outcome is not always achieved.

Success Rates Of Dilation

The following table gives a quick summary of all the major studies in the past 25 years.

As you can see, death rates are low but success only occurs in around 2 in 3 cases. Study 6 remains an experimental approach which (in my opinion) will end up with similar success and mortality rates if and when it becomes more widely used.

Management after dilation generally includes administration of various drugs to reduce gastric acidity, increase forward movement of the gut, and reduce scarring during healing.

Failure of dilation has in the past been sometimes followed by further surgical procedures, especially stenting and resection. Neither have sufficient success to be routinely recommended.

Do All Cases Need Treatment?

If you have a dog or cat with an oesophageal stricture, I hope that this information will allow you to make an informed decision. Whether to have dilation performed will come down to four things:

1. How well your best mate is coping,
2. The potential risk of aspiration pneumonia or megaoesophagus in your case,
3. How much special care will be needed over life if you don’t,
4. Sadly, also costs

Specialist veterinary care is unquestionably expensive, and I would prepare for around $5000. Costs will vary depending on how many dilations are needed. It might help to know that several papers observed that a favourable outcome was often associated with good results from the outset.

Most referral centres are quite willing to talk about their fees, especially to us vets, so it’s your right to ask. Good luck.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

References

1. Adamama-Moraitou, K. K., Rallis, T. S., Prassinos, N. N., & Galatos, A. D. (2002). Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases. Canadian Journal of Veterinary Research, 66(1), 55 
2. Bissett, S. A., Davis, J., Subler, K., & Degernes, L. A. (2009). Risk factors and outcome of bougienage for treatment of benign esophageal strictures in dogs and cats: 28 cases (1995–2004). Journal of the American Veterinary Medical Association, 235(7), 844-850
3. Harai, B. H., Johnson, S. E., & Sherding, R. G. (1995). Endoscopically guided balloon dilatation of benign esophageal strictures in 6 cats and 7 dogs. Journal of Veterinary Internal Medicine, 9(5), 332-335
4. Leib, M. S., Dinnel, H., Ward, D. L., Reimer, M. E., Towell, T. L., & Monroe, W. E. (2001). Endoscopic balloon dilation of benign esophageal strictures in dogs and cats. Journal of Veterinary Internal Medicine, 15(6), 547-552
5. Melendez, L. D., Twedt, D. C., Weyrauch, E. A., & Willard, M. D. (1998). Conservative therapy using balloon dilation for intramural, inflammatory esophageal strictures in dogs and cats: a retrospective study of 23 cases (1987–1997). Eur J Comp Gastroenterol, 3(1), 31-36
6. Tan, D. K., Weisse, C., Berent, A., & Lamb, K. E. (2018). Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats. Journal of veterinary internal medicine, 32(2), 693-700

When Is A Swollen Belly An Emergency?

Dogs with any of these symptoms need to be taken to a vet immediately:

• Vomiting
• Hard, painful abdomen
• Collapse
• Severe lethargy
• Not eating

Now dive deeper…

The picture above shows what a dog’s normal body shape should be.

Could it just be fat? The answer is usually ‘no’. Overweight dogs are so common that they look normal to most people. Therefore, trust your instincts: if the stomach looks odd, it’s almost certainly not just fat.

For example, the pictured dog isn’t fat anywhere else, and the belly hangs down more than it should. Even though he seems well, he’s in a lot of trouble.

Causes Of An Enlarged Abdomen

There are many reasons why the stomach gets bigger than normal. I’ll classify them by the cause of enlargement and start with the most serious. There are two special cases in puppies near the end.

Gas: Bloat

Bloat or GDV occurs when the stomach suddenly twists and blocks the escape of gases. Gastric expansion follows, and without treatment dogs die a rapid and horrific death.

Affected dogs are usually large breeds with obvious distress and a hard, painful abdomen. If your dog is comfortable and eating or drinking, they don’t have bloat. You can read more about the causes and prevention of bloat here.

Sometimes a dog’s stomach swells up with gas for less serious reasons, like overeating. I saw one this week which happened with no obvious cause. These dogs need xrays to tell them apart from life-threatening cases of bloat, and to monitor the stomach size.

Pain: Peritonitis

Abdominal pain makes dogs hold their belly stiff and tight like a drum. We call this splinting. You should always treat this sign as an emergency.

The most common cause is pancreatitis, which you can read about at the link. However, this is indistinguishable without testing from other causes of inflammation or infection, such as:

• Intestinal obstruction from swallowing the wrong thing
• Ruptured or twisted bowel
• Gall bladder diseases
• Gunshot or stake injuries

Blood: Haemorrhage

Internal bleeding can cause the belly to look bigger, however it’s rarely the most obvious sign. These dogs are also usually weak, pale, lethargic or even collapsed.

There are two common causes of abdominal bleeding:

1. Eating rat poison stops the blood from clotting, and although there’s an antidote, most dog owners haven’t realised their dogs ate it until symptoms begin
2. Haemangiosarcoma is a tumour of the spleen whose first sign is often unexplained blood loss

It’s also very possible to have abdominal haemorrhage after any major surgery or injury. Obviously, whatever the reason, bleeding is always a critical emergency.

Urinary Tract Damage

Damage anywhere in the urinary tract can cause urine to leak into the abdomen. The most common reasons for this are bladder stones blocking the urethra, and car accidents.

Like with bleeding, the amount of fluid is mostly small, and other more obvious signs of illness are present, like lethargy, straining or pain.

Food: Overeating

A classic and sometimes serious cause of bloated stomachs is when a dog biscuit bag is left out while you’re not at home. Most dogs will binge on the kibble until they can’t eat any more, then the kibble starts to swell as it takes on water. These dogs often need the vet to induce vomiting to relieve the distress.

In puppies, abdominal distension after eating is quite normal. As long as they are bright and playful, and it goes down in a few hours, there’s nothing to worry about. However, the next cause also needs consideration…

Parasites: Worms

Intestinal worms are a very common and serious reason for a swollen stomach in a young puppy. Roundworms (pictured) often get large and numerous enough to swell the belly and block the passage of food.

Read all about preventing and treating intestinal worms here.

Fluid: Ascites

Many diseases cause the buildup of a clear fluid that we call a transudate. Most of these slowly worsen without any other major signs of illness. Examples might be:

1. Heart disease
2. Caval syndrome from heartworm
3. Portal vein obstruction from tumours
4. End stage liver disease
5. Certain widespread cancers
6. Protein-losing enteropathy
7. Protein-losing nephropathy

The first four happen because the blood pressure in abdominal vessels gets high enough that fluid leakage occurs. Number 5 is simply because fluid often escapes from tumours with a high surface area.

Numbers 6 and 7 are probably the most common. They happen when blood proteins are being lost through the gut or via kidney disease. This leads to a drop in plasma oncotic pressure, which causes fluid to leak from small vessels. The fluid will also often be present in the chest cavity.

Testing is essential to identify and treat the cause. Often all of the following are needed:

• History & physical exam
• Ballottment of the abdomen (percussing one side of the belly and feeling for a fluid wave on the other)
• Blood and urine tests
• Ultrasound exam
• Intestinal biopsy

The most common cause is inflammatory bowel disease as a consequence of protein-losing enteropathy. You can read about that here. As you can imagine, without treating the cause, drainage of the fluid is usually useless.

Fat: Hormonal Diseases

Even though fat deposition is unlikely, there are two diseases in which it is laid down in a way that can look like a swollen stomach. These are:

• Cushings disease, associated with an enlarged liver, pot belly, hair loss and excessive drinking
• Thyroid disease, associated with lethargy and unexplained weight gain 

You can read about tests and treatment for both diseases at the links.

Masses & Enlarged Organs

Sometimes a tumour in the abdomen can get so large that it causes the belly to noticeably bulge. These are usually slow-growing benign masses, otherwise they would have caused other signs earlier. Swelling can also occur when organs themselves become enlarged. Perhaps the most important are the liver and spleen. 

Diagnosis requires blood testing and an ultrasound exam. Even large masses can often be removed if there is no evidence of spread.

Uterus: Pregnancy & Pyometra

Lastly and very rarely I have seen owners of a female dog not be aware of a mating 5 to 6 weeks earlier. In older un-desexed females, a uterine infection called pyometra or reproductive tract cancer can also swell the abdomen in a similar way. 

These unplanned events should be a lot less common now that desexing has become compulsory in Adelaide.

I’ll end on a positive note. Despite some of the horrendous diseases mentioned here, most causes of abdominal enlargement that I see are the ones that can be treated, often with just a tablet. Therefore, don’t be frightened of getting the vet to take a look. It’s usually all for the better.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Lymphoma is caused by the abnormal multiplication and growth of lymphocytes. These are a white blood cell found throughout the body, including the bloodstream, gut and lymph nodes.

Signs Of Lymphoma

The main signs of lymphoma in cats are vague illness, weight loss and reduced appetite. Other signs depend on the organ affected by the tumour, and can include:

• Diarrhoea (see other causes at the link)
• Abnormal swellings
• Drinking more
• Intermittent vomiting
• A runny or blood nose

Diagnosis of Lymphoma

The diagnosis of lymphoma in cats is rarely straightforward. It often starts with seeing the vet for a vague general sign like weight loss. A physical exam might suggest blood testing, leading to further tests like an ultrasound exam.

Only a surgical biopsy will give an accurate diagnosis. A needle biopsy alone, while useful, can only tell you that it’s lymphoma. It’s essential to know what type of lymphoma it is before you make a decision on whether to treat or not.

Two other causes of abdominal lumps easily confused without investigation are FIP and hairballs.

High grade alimentary lymphoma and renal lymphoma have a very poor prognosis. Reported median survival times even with treatment are only around 3 to 4 months. That’s in contrast to nasal lymphoma and small cell alimentary lymphoma which have reported survival times of several years with treatment. There is even a solitary form which can be surgically cured, but this is rare.

Beware of older information giving a blanket statement like “cats live on average for a year after diagnosis of lymphoma.” This figure derives from studies where the types of lymphoma were not separated, and is virtually meaningless today.

Treatment Of Feline Lymphoma

Treatment depends on the type and location of the tumour.

High grade alimentary lymphoma, renal lymphoma and other systemic large-cell forms are treated with traditional chemotherapy protocols. These involve visits to the vet for injections, tablets and blood tests. The number and duration of visits will depend on the protocol chosen.

Nasal lymphoma is treated with similar drugs plus the use of radiation. Unfortunately, licensed radiation therapy is only available in a few capital cities. For cats in Adelaide, that means a long trip for treatment, if at all.

Small cell alimentary lymphoma is treated with alternating doses of prednisolone and chlorambucil given at home on a daily basis.

To Treat Or Not?

There is no right or wrong answer on whether to treat lymphoma in cats. However, here are my opinions based on 25 years of experience:

1. If there’s any chance you’ll treat, don’t delay. Excessive weight loss will worsen the chance of responding to treatment.
2. Small cell alimentary lymphoma and nasal lymphoma offer compelling cases for choosing treatment, based on their long average survival times.
3. Other lymphomas have lower response rates: only 30% of cats achieve full remission with alimentary forms versus 52% in all other locations (remission is the disappearance of signs and symptoms).
4. Despite this, lymphoma treatment is worth trialling to see if remission can be achieved. That’s because the survival time for a cat that can achieve remission is much better at around one year. If there is no response, or illness occurs, it’s easy to stop.
5. Euthanasia is a reasonable and compassionate choice which cannot be criticised. Read more about taking this difficult choice here.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

When A Dog Eats Grape Products

1. Grapes are toxic whether dried, fresh or cooked
2. The toxic dose is highly variable
3. Removal via vomiting and treatment of kidney damage gives good results

Now dive deeper…

Why Grapes Are Toxic

It is believed that tartaric acid is the toxin in grapes responsible for kidney injury. Not just grapes, but also raisins, sultanas and currants, even when baked into cakes or biscuits. Here in South Australia, an added hazard is marc, a grape residue from winemaking.

Grape poisoning is reminiscent of the kidney damage we see from dried meat treats although the toxic ingredient will not be the same.

How Toxic Are Grapes To Dogs?

The puzzle at the heart of grape poisoning is why some dogs can eat a large amount and be unharmed, whereas others eat tiny amounts and die. Presumably it is because the tartaric acid content varies considerably. There are reports of dogs eating a kilogram of raisins and being unaffected, or a handful of sultanas and dying.

These are the lower end of reported doses that caused illness:

The lowest toxic dose ever recorded was 4 to 5 grapes in an 8.2 kg Dachshund. That dog survived with treatment.

When To Go To The Vet

If you know your dog has eaten grapes, you should go to a vet straight away to induce vomiting. If it’s at night, that means a trip to the emergency vet. They should be able to remove the majority and provide activated charcoal to mop up any that slipped through.

So how many grapes constitute an emergency? Using the Dachshund as a guide we can say that one grape or sultana for every 2kg of bodyweight is probably the worst case scenario. However, given the uncertainty, it’s recommended to go to the vet to have even a single grape vomited up.

After 2 hours have passed, most of the grapes will have left the stomach. However, grapes, sultanas and raisins seem to leave the stomach slowly so I would still be inducing vomiting for up to 24 hours. 

If you miss the chance, the earlier we start treatment, the better their chances. Therefore, visit your vet for a blood test to check for kidney damage. A normal result in a grape-exposed dog is shown here.

Signs Of Grape & Sultana Poisoning

The earliest and most reliable sign of serious toxicity is vomiting, typically starting within 24 hours. Other signs include:

• Diarrhoea
• Weakness & lethargy
• Not eating
• Blood in vomit or stools
• Neurological signs such as dullness and ataxia (wobby legs)

Sometimes you can see grapes, raisins or sultanas in the vomit or faeces.

If your dog starts vomiting, and there have been grapes around, don’t ‘see how he is in the morning’; visit a vet immediately. The same applies to other toxic causes of vomiting like Nurofen®.

After 24 hours, signs of acute renal failure are likely to appear in these dogs. This will most often just look like a dog that gets sicker and sicker. A blood test will easily show the extent of the problem and what needs to be done.

Treatment Of Grape Poisoning

If the grapes can be removed from the stomach quickly, there may be no need for further treatment. However, when kidney damage is suspected we should closely monitor these dogs via repeated blood testing.

Treatment is support of the kidneys until they recover. We use high rates of fluids to flush the toxins, and sometimes diuretics to encourage urine flow. Dogs that receive treatment early are more likely to survive.

Other treatment depends on the individual, such as replacement electrolytes, antiemetics or antacids. 

The prognosis for recovery is excellent if treated early. Acute kidney injury only occurs in around 5% of early-treated poisonings, and mortality rates are around 1%.

The hardest thing is prevention. Grapes always fall off bunches and most dogs pounce on them fast. Sultanas and raisins in baked goods are everywhere.

The best thing is to only carry and eat grapes in bowls or bags, and recognise the danger of fruitcakes and buns. There will always be the one that gets away but I hope this article helps you decide what to do when it does.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

These figures might be exaggerated*, but they speak to a wider truth. There is no doubt that most feline pancreatitis (FP) goes undetected, regardless of the numbers.

Gom, pictured above, is a good example. He’s always seemed healthy. Yes, he vomits occasionally and isn’t always hungry but that could be said for many cats.

It wasn’t until he came in with lethargy and a fever recently that I suspected he had pancreatitis. Even then, I had no other evidence except a hunch.

The problem is that you don’t find feline pancreatitis by accident. 

Diagnosis Of Pancreatitis In Cats

Despite being common, FP does not appear on any routine test. There is a good test that can pick up most cases, but it’s still not widely used. So what’s holding us back?

The feline pancreatic lipase, or fPL is limited by being owned by one pathology company. That’s probably why it’s pricey and not yet standard in all wellness testing, even though it clearly should be.

Adding it to the price of our wellness tests takes them from $130 to $170. Perhaps this doesn’t seem much until you realise that there are 50-plus other tests in the basic profile. If all of them cost the price of an fPL, tests would be well into the thousands.

It’s still up to the vet to decide when when the extra costs are justified and to recommend adding an fPL.

fPL is the best test, but still not perfect. It has a reported sensitivity of around 75%, meaning it will miss one in four cases. For these, we use ultrasound or perhaps even surgical biopsy but there will always be a few we miss. That’s why it’s important to not give up when investigating vague symptoms, even when the tests are negative.

What Is Pancreatitis?

To understand pancreatitis, all you need to do is ask, “how does meat eat meat?” How can one animal safely digest another without digesting itself in the process?

The answer is the use of enzymes that remain inactive until they reach the food in the gut. Pancreatitis occurs when something triggers these enzymes to activate while still in the pancreas. Then it’s like an explosion in a fireworks factory.

Risk Factors For Pancreatitis

The problem for cats is that we don’t yet know what these triggers are. Although pancreatitis in dogs is strongly linked to fats in the diet, this isn’t true for cats. All we know is that older cats and males are more likely to be affected. 

Until we know more there’s precious little that can be done to reduce the risk for an individual cat. I always advise weight loss if a cat is overweight. However, as much as I might suspect this adds to the risk, I have no evidence other than a suspicion.

All we can do is be aware of the signs and know what to do about it. 

Symptoms Of Feline Pancreatitis

Signs of pancreatitis are vague and vary in each cat. They include:

• Lethargy
• Not eating
• Vomiting
• Diarrhoea
• Fever
• Pain

Most cats, however, only show lethargy and a reduced appetite. Only 50% will vomit, and even less have diarrhoea or a fever. All have pain, if only we could detect it.

Treatment Of Pancreatitis 

There’s a lot of talk about treating acute versus chronic pancreatitis. Although in reality they overlap, the concepts are still useful. Acute disease is rapid in onset and usually more severe. Chronic pancreatitis is a cyclic and ongoing problem that’s probably less severe but of much longer duration.

Cats with acute pancreatitis (like Gom) are likely to need hospitalisation. Treatment is supportive, and includes intravenous fluids, anti nausea drugs, and most importantly pain relief.

Many of these cats start eating within 24 hours and can go home. Those that don’t will need assisted nutrition (often via feeding tubes) and potassium added to their fluids. A large study of these cats shows a 78% survival rate which was worsened by a delay in getting to the vet.

Cats with chronic pancreatitis rarely need to stay in hospital, but require ongoing home care. The best thing an owner can do is to learn to recognise the signs and administer anti-inflammatories and pain relief. These drugs usually work very well to prevent or control flare ups and keep cats healthy.

Complications Of Pancreatitis

The sharp-eyed among you will have already noticed that both pancreatitis and diabetes are diseases of the same organ. And it’s certainly true that each one complicates the other.

A cat with diabetes who develops pancreatitis becomes very hard to manage, and is often best referred to a specialist. A cat with repeated bouts of chronic pancreatitis is likely to be at a higher risk of diabetes.

Triaditis is a term used to describe having liver inflammation and inflammatory bowel disease together with FP. So far there’s not much evidence that one causes or is related to the other, as all are common in old cats. Personally, I think most of these will just be coincidences but only more studies can tell us.

How To Help Your Cat

So I said your cat might need your help. Here’s how.

If your cat just seems vaguely ‘off’ or not like he or she used to be, it might be nothing. However, since that’s all we get for pancreatitis, at least once in their life it’s worth a test during one of these periods.

If it’s pancreatitis, you should be able to find out. If it’s not, a blood test is still a useful thing, even if it’s normal. I haven’t met someone yet who got a normal blood test back and told me it was bad news!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

* This study was done via post-mortem examination of cats who died from any cause, and looked at the pancreas extremely thoroughly. Possibly some the damage seen wasn’t significant.

How To Tell If Vomiting Is Abnormal

A ‘normal’ vomit should be quick, happen once only and not be accompanied by a loss of appetite. A good rule of thumb is that if a cat vomits once a week or more, you should get them checked by a vet.

Other important reasons to visit the vet are:

• weight loss
• a poor appetite
• blood in the vomit
• being under one or over ten years old
• having other symptoms such as diarrhoea or lethargy

Causes Of Vomiting In Cats

The causes of vomiting in cats range from simple things like hairballs, food intolerances or eating too fast to serious illnesses like kidney disease and cancer. Your vet should be able to tell if the problem is serious or not.

Hairballs

Hairballs are not as common a cause of vomiting as most cat owners think. Cats swallow hair every time they groom and often carry harmless hairballs in their stomach. Then they vomit, and hey presto: the hairball gets blamed.

Though rare, hairball problems requiring surgery do sometimes occur in long-haired breeds. For short-haired cats, a hairball should only cause a very occasional single vomit. The cat should be otherwise perfectly happy, healthy and have a good appetite.

Read more about the treatment and prevention of hairballs here.

Over-Eating & Rapid Eating

Vomiting is more common when cats are given free access to large meals. It’s just that some cats aren’t very good at eating slowly or stopping at the right time. This is especially true for dry foods, that start to swell once they moisten in the stomach.

Rapid eating is also a problem in cats who feel like they have to compete for food. The result in both cases is usually a firm cylinder of vomited food that doesn’t look like it’s been digested at all. Usually it comes up shortly after eating.

For all cats, stopping dry foods may be needed, but it’s better to use a food dispenser or teach your cat to accept small regular meals. Prevention in multiple cat households should start by allowing them to eat their dinners separately.

Food Intolerances

Just like people, cats can be intolerant of certain foods. Like in the previous example, they should be otherwise normal in health. However, as adverse food reactions are not all that common, it’s important to rule out the more serious reasons for vomiting first.

Once that’s done, you can visit this page on restricted and elimination diets for adverse food reactions.

Gastritis & Gastroenteritis

Cats aren’t as silly as dogs. However, even they will sometimes eat something they shouldn’t. Many of these cats need treatment but should make a full recovery. We almost never identify the cause.

Cats with outside access get more of these stomach upsets, probably due to infections from birds, reptiles or rodents they eat.

Foreign Bodies

Even sillier cats, and especially kittens, sometimes eat foreign material. One cat started vomiting after eating the string that wraps meat, whereas others have eaten cooked bones, fish hooks, toys and even babies’ teats.

The worst cases come from swallowing string, which is why we never advise playing with it. It gets caught on their rough tongue and they seem to almost swallow it by accident.

Worms

Parasites are probably an unusual cause of vomiting, although we can’t be certain. Just to be sure, I always worm cats that vomit frequently.

To illustrate just how vague a symptom it is in cats, vomiting is also one of the signs of feline heartworm. That’s thankfully quite rare these days.

Medications

Nearly all medicines can cause vomiting, so if your cat takes something please make sure you tell your vet.  Particularly common culprits are treatments for feline arthritis and hyperthyroidism.

Viruses

Many viral infections sometimes have vomiting as part of their symptoms. These include feline infectious peritonitis (FIP), feline panleucopaenia (also called feline enteritis or parvovirus) and feline leukaemia virus (FeLV).

The last two have effective vaccinations. In Adelaide cats certainly need the feline enteritis vaccination but we don’t have much leukaemia virus to worry about.

Vomiting In Older Cats

There are special reasons why a mature cat might vomit that are rare in young cats. Here are the most common.

Constipation

Vomiting in an older cat can have any number of explanations but in my clinic, the number one cause is constipation. These cats usually look and act well, but are vomiting a little more often and may have lost some weight.

These are the same symptoms as the next five causes so please don’t treat your cat for constipation without seeing the vet first. Once it’s confirmed, visit our page on the treatment of constipation in cats.

The next five are all diagnosed or excluded by routine wellness blood testing.

Hyperthyroidism

Cats with excessive thyroid hormone levels commonly have a ravenous appetite. A bit like the rapid eaters and over-eaters I mentioned earlier, this can lead to vomiting after meals. Visit this page for more on thyroid problems in cats.

Chronic Kidney Disease

Kidney problems are always high on our suspicions if an older cat is vomiting but drinking more. Other signs are a reduced appetite and weight loss.

Visit here for diagnosis, staging and treatment of feline kidney failure.

Pancreatitis

There is no doubt that we are still missing some cats with pancreatitis despite having a new test. The good news is that we’re much more aware of it than we used to be, and treatment is generally successful.

Liver disease

Cats get a range of liver diseases, but especially cholangiohepatitis. It requires a biopsy to diagnose but is then usually easy to manage.

Diabetes

Diabetes in cats is another common disease, especially of the overweight and middle-aged. It’s not at all a death sentence with modern insulin choices like glargine.

IBD

What we call IBD or inflammatory bowel disease is really a very poorly understood chronic problem. It causes vomiting, diarrhoea and weight loss over many months. Intestinal biopsies are essential for its diagnosis. Read more about IBD in cats here.

Neoplasia

The most common cancer of the gut in cats is small cell lymphoma. It looks exactly the same as IBD until biopsies are done, but is quite treatable once diagnosed.

Many other tumours and cancers can affect the gut of older cats just like many other species. Most can be removed if diagnosed via ultrasound in time.

Related: Causes of vomiting in dogs.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

How To Recognise & Treat Bloat

1. Retching, distress and a large, hard belly are signs of bloat
2. Travel to an emergency vet as fast as is safe to do so
3. Any delay in treatment reduces the chance of survival

Now dive deeper…

When a dog’s abdomen suddenly enlarges, it can be one of the most serious emergencies of dogs. Therefore, if your dog is in distress, stop reading this and get to a vet straight away. Their life may depend on it.

There are a lot of other causes of an enlarged abdomen in dogs that you can read about at the link. This page is your evidence-based guide to bloat and how to prevent it.

What Is Bloat?

Bloat, also called Gastric Dilation Volvulus or GDV, is when a dog’s stomach both enlarges and rotates on its axis, blocking the outlets. Accumulation of trapped gases then causes the stomach to swell rapidly and put pressure on the surrounding organs and blood vessels.

Bloat is a true emergency with the same urgency as snake bites and poisonings. Rapid recognition and treatment of the problem gives good results, but delays are fatal.

What Causes Bloat?

Although it isn’t fully understood, bloat happens when:

1. The stomach is unusually full
2. The supporting ligaments are weakened
3. The dog’s chest shape allows rotation

In other words, it’s more common after eating in certain breeds at a mature age. Those with a narrow and deep chest are at a much higher risk.

In large and giant breeds, bloat is the second most common cause of death after cancer. On average, one in six will be affected with a case mortality rate of between 30 and 50% depending on the study.

The risk varies greatly with individual breeds, reaching almost 50% in Great Danes. Here is a list of the dog breeds commonly reported to be prone to bloat:

• Akita*
• Basset Hound
• Chow
• Doberman
• Dogue de Bordeaux
• German Shepherd
• Great Dane
• Irish Wolfhound
• Rottweiler
• Saint Bernard
• Setters (all)
• Standard Poodle
• Weimaraner

Any large and giant breed can get it, even Labradors and Golden Retrievers. I have also seen it in a Miniature Dachshund.
* probably the American form

What Are The Signs Of Bloat?

Bloat normally happens within several hours of a meal, making it a classic nighttime emergency. Signs include:

• Restlessness, pacing and signs of discomfort
• Drooling and retching without producing food or bile
• Panting or rapid breathing
• A large or tight belly

What distinguishes bloat from just an upset tummy is the obvious distress of your dog. Most dogs with gastro still act normally between vomits but a bloated dog is totally focused on the problem. Whether it’s bloat or not, this is always a sign to seek emergency help.

Treatment Of Bloat

There is no home treatment of bloat, and it almost never resolves on its own. Time is critical. The expanding stomach is in danger of being irreversibly damaged as well as obstructing the major abdominal blood vessels.

After diagnosing bloat via an x-ray, your vet will immediately place a drip and attempt to pass a stomach tube. Whether this is done under sedation or anaesthetic depends on the state of your dog.

In most cases, the tube cannot pass into the twisted stomach and urgent surgery is required. This allows the stomach to be de-rotated and decompressed. After this, the surgeon will surgically fix the stomach in its normal position in a procedure called gastropexy.

A recent study showed that 80% of dogs that have bloat surgery will survive.

How To Prevent Bloat In Dogs

Evidence-based ways to reduce the incidence of bloat are based on how you feed large dogs:

• Feed multiple smaller meals per day instead of one large meal
• Use ‘slow feeder’ bowls or treat dispensers for dogs that eat quickly
• Food bowls should be at floor level, not raised.
• Avoid higher fat dog foods
• Table scraps reduce the incidence, suggesting that ‘natural’ diets may help
• Feeding dry or wet food makes no difference

There is also weak evidence that avoiding exercise straight after feeding may be helpful. None of these methods is going to reduce the risk to zero, but you can make a big difference.

Other factors that influence the risk of bloat are:

• Health: dogs with prior medical or digestive problems are at higher risk
• Stress: strangely, stress makes dogs more likely to bloat
• Body condition: very lean (skinny) dogs get bloat more often
• Surgery: gastropexy surgery is extremely effective protection once a dog has already had bloat
• Genetics: the most important, but the one you can’t change once you’ve selected that puppy

Breeding To Prevent Bloat

So let me finish by talking frankly about the breeding issue. Bloat today is five times more likely in a pure-bred than a cross breed. You saw the picture of the Great Dane earlier. Now, look at the chest shape of a Great Dane from 100 years ago. I’ll bet you that this dog hardly ever got bloat.

However, this isn’t the only breed at risk.

One of the greatest predictors of whether a dog will get bloat is whether it happened to a close relative. Unless breeders are actively choosing dogs from lines that don’t bloat we can’t fix the problem. That will also require kennel clubs to stop giving prizes to dogs with the long narrow chests.

And it will take pressure from puppy buyers asking breeders if any of their dogs have bloated. It’s frankly scandalous that preventative bloat surgery is now considered a normal part of owning some breeds. You may also need to learn to love the shape of dogs they way they were meant to be.

But of course you will!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.