The Importance of Annual Exams (even for young “healthy” animals)

I realize it has been awhile since you have heard from me. Things can get a little crazy in a household with 2 human-kids, 3 cat-kids, and a husband that travels for work. Throw in some laundry and other household chores, add homework and a few school shows, toss in a spring break trip to the other side of the world to visit extended family, and let’s not forget professional obligations and work deadlines. It is easy to see how my “free” time vanishes, quickly. But this week I had something unexpected, and more than a little worrisome, come up with one of the cats that reminded me it is always important to stop and pay attention to our pets, even if they look normal on the outside.

Our seemingly healthy, 3-year-old, female spayed, domestic short haired cat, Cosette, is unwell. You wouldn’t know it by looking at her, of course. She’s grooming normally and her coat looks great; she has been eating and drinking normally (loves her food!); she has been tussling with the 1-year-old trouble maker; rolling over for belly rubs (loves having her belly rubbed for as long as you are willing to do it!); and she isn’t now, nor has she even been a vomiter. The litter boxes for the 3 cats are virtually unchanged (I say virtually because Oliver being 18, has less concentrated urine so when the first wetter pee showed up in box that Cosette and Loki prefer to use, I just thought Oliver must have jumped in). Cosette has always been my easy keeper. She can eat anything, tolerates just about anything, she is sweet, affectionate, never a concern. Until now.

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Even in the exam room today, Cosette still likes her ears scratched.

 

 

We came back from our recent spring break trip to find Cosette looking a little rounder in the belly than normal. I initially thought that maybe the friend who was checking on the cats had been overly generous with the food love, or that maybe Cosette hogged more than her fair share when no one else was around. (It’s been known to happen before. The one and only time we tried to leave the 3 cats for more than an overnight, and without a cat-minder, Cosette must have eaten 4 days’ worth of food for 3 cats all by herself.  When we got home on Day 3 the boys, Oliver and Loki, were looking a bit gaunt and were very glad to see us, while Cosette was casually lounging on the sofa looked like she had gained a couple pounds.) Needless to say Cosette has always enjoyed her food and has always been on the voluptuous side, so round belly this week wasn’t an immediate red flag. But just a few days ago while I was petting her I thought she seemed to have lost some of the muscle mass along her backbone. I gently felt her belly again and thought maybe it was a bit too round.  When I pushed a little deeper I felt a firm, lumpy mass around her left kidney. That she really didn’t like me pushing on.

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The picture of health? Cosette just 2 days ago.

 

Luckily one of my new vet friends here was willing to meet me at his clinic on his day off to take some images of her abdomen. Turns out that what I thought was a mass around her kidney was her kidney. Not only did she have left hydronephrosis (hydro– means “fluid”,  –nephrosis means “kidney disease”, so hydronephrosis  literally means fluid distended left kidney), but on ultrasound she had quite a bit of ascites (free fluid in her abdomen) as well as abdominal lymphadenopathy (enlarged lymph nodes). The big kidney and ascites were what was giving her the portly appearance, not extra kibble and treats. Blood work was boring (even low normal kidney values and normal red blood cell concentration), but her urinalysis was dilute, so her kidneys not only looked unhappy, they were starting to act unhappy, too.  She is having a few additional tests today and right now she is feeling ok, but that could change any day. I don’t have all the answers about her condition yet, but it doesn’t look good.

Either way I wanted to take the time to share 4 things I’ve been reminded of in the last 48-hours.

  1. Every dog and cat should have an annual wellness exam. Even “healthy” animals can be hiding things like dental disease, heart disease, or kidney disease. Cosette’s condition is an extreme example of what can happen in a young cat with no outward signs of illness. Annual wellness exams are a quick and easy way to check in with your primary care veterinarians and allow them to get to know your dog or cat and hopefully catch problems before they get out of control. Annual physical exams are not the same as “vaccine appointments”. Vaccine schedules and plans vary by geographic area and the individual’s risk factors, but annual physical exams are important for every dog and cat no matter where they live and spend their days. Your primary care veterinarians will look in their eyes and ears; examine teeth and gums; listen to heart and lung sounds; palpate (i.e., feel) over glands, lymph nodes, and abdominal organs; and (for dogs) will perform the unpleasant, but very important, rectal exam. I like a good medical challenge just like the next vet, but I much prefer preventing illness or at least catching it early enough to give the best chance of recovery.

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    You won’t find anything if you don’t look.

  2. Medical problems caught early are often easier to treat then those found after the animal becomes “sick”. I can’t tell you how many times I’ve examined seemingly healthy dogs and cats before a diet change and then found underlying kidney disease, early hypo- (dog) or hyperthyroidism (cats), elevated liver enzymes, high cholesterol and triglycerides, or an asymptomatic bacterial bladder infection on additional screening tests. We found these medical conditions in the early stages because we looked, not because the animal was acting sick. The caregivers in every case had reported no change in appetite or behavior and outwardly the dog or cat looked fine. Believe me, it is a lot easier to transition a dog or cat to a new diet when they are feeling good rather than when they are feeling bad. If you wait until the dog or cat is in kidney failure and has started to refuse all food, of course they’re not going to eat the vet theraputic diet.  They don’t want to eat anything.  This is not to say that every dog and cat should have full blood work and urine test repeated every year, but I recommend a healthy adult screening (around 3-4 years of age) and then repeating specific tests depending on individual risk and annual exam findings.

    Pet-library---feeding-a-cat

    Make their regular diet the best diet for all of their health needs.

  3. Know your dogs and cats. I am definitely not advocating that caregivers stay home 24/7, follow their dog or cat around nonstop monitoring their every move, but some attention to small details is a good idea. If the cat is normally the first one to the food bowl, but starts hanging back or even starts to lose weight despite eating well, is there a social stressor (if you have multiple cats) or something else going on? If you normally scoop small, firm urine clumps out of the litter box, but lately have noticed the clumps fall apart or the urine has spread out and don’t form a round clump (without any change in litter or food type), a trip to the vet may be warranted. If your dogs or cats eliminate outside, once or twice a week walk out with them and watch what happens. Are they posturing to urinate or defecate without producing anything? Squatting multiple times instead on just one longer time? Or do they go out, do their business and then bounce back inside? When you’re brushing your dog or cat, get in the habit of also running your hands over their torso, arms and legs feeling for lumps and bumps. Like an extended rub down of love. If you don’t find any then great! But if you are familiar with what should and shouldn’t be there, you may be able to pick up something when it is small and relatively easy to address. I worked with a caregiver who could predict a pending drop in their dog’s blood albumin (blood protein) level simply because they felt a change in muscle mass. And another who caught their cat’s diabetes in the early stages because they always used a measured cup to fill the water dish and notices that they were filling in more frequently. You will know your dog or cat’s day-to-day habits better than any veterinarian, which can be a powerful tool if (when) they get sick.

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    You and your primary care vet make the best team.

  4. Every day of seemingly good health is a gift. I know, sappy sentiment alert. No matter what we find out this week about Cosette’s disease, I know now that we will have less time with her than we expected. Could be weeks if it’s cancer (which would really and truly suck), could be years if it is a stone blocking her kidney flow (still sucky, but then she’d at least have a longer life span). When we adopted her from our local shelter 3+ years ago, Cosette was a cute playful ball of fluff and both kids fell instantly in love with her. We all expected her to be with us for at least 15, if not 20 years. Now her future is a question mark.  I know bad things happen to good people and animals.  Sometimes we can prevent illness and sometimes we can’t. We can’t control everything, but what we can always do is show our love for the friends and family members.
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Cosette in her younger, carefree days.

 

Happy Feeding and Hugs to Your Dogs and Cats!

Lisa P. Weeth, DVM, MRCVS, DACVN

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