Amir Anwary a TikTok veterinarian gives us three vital tips on cat caregiving

It is always nice to have a veterinarian provide cat caregivers with useful tips on how to improve cat ownership. There is always a need to improve it although I think we can argue that the Internet has been incredibly useful in educating millions of caregivers.

Amir. Screenshot.

Amir Anwary says that three important cat caregiving tips would be to (1) if you need to change your cat's diet do it slowly to avoid stomach upset and (2) watch out for your cat's changes in behaviour as it might point to a severe disease and (3) know the signs of kidney disease because this is a very common disease in older cats.

I will briefly touch on these three points.

Changing diet slowly

For me, this applies mostly to reducing your cat's food intake because they are obese. There is an obesity epidemic according to veterinarians amongst the cat population in the West and therefore a lot of cat caregivers will be considering reducing their cat's diet. It should be gradual in order to avoid hepatic lipidosis which is fatty liver disease, a serious disease. You can read about that disease and how it develops by clicking on this link.

As to changing a cat's diet by changing the wet cat food you provide them, I don't think that will cause upset. I am presuming that you buy decent or high quality commercially prepared wet cat food. They are very similar if they are balanced and complete. Your cat will like the food or possibly reject it. You are currently giving them a food they like. If you give them new cat food which they reject then there is no change in diet! Problem solved.

Changing from a good quality wet food diet to a full-time low quality dry food diet will probably cause stomach upsets and may well affect a cat's health detrimentally. There are strong arguments for not providing dry cat food as the sole diet for a domestic cat because it's too unnatural and cats don't compensate sufficiently by drinking more water. 

It's been argued that this kind of diet can lead to cystitis if the environment in which the cat's lives is also stressful. Stressing cats is probably more common than people think particularly in multi-cat homes. Cat caregivers should look out for signs of stress particularly in timid cats who might be prone to hide and are being bullied.

Changes in behaviour

If everything else has stayed as normal by which I mean the environment in which the cat lives, and the cat suddenly starts to behave differently by hiding or becomes lethargic and losses appetite (common signs of illness) then a caregiver might presume there cat is ill. It might be a serious illness. There would be a need to take him or her to a veterinarian for diagnosis.

These changes should be pretty apparent to an observant and reasonable cat owner. Amir Anwary is simply reminding cat caregivers to be aware of these changes in order to allow a veterinarian to tackle any underlying health problems promptly. That I think is the message he is trying to deliver in his TikTok video. A good one.

Kidney disease

As Amir Anwary states this is a very prevalent disease in elderly cats in the West and is probably due to cats living longer (as occurs in humans) and the environment in which they live which may contain pollutants which are hidden or unknown by the owner and thirdly the diet might predispose the cat to this particular health problem. More work needs to be done on this in my view. There may be an inherited genetic element too.

Diabetes can damage the kidneys and diabetes is a growing disease in our feline companions. The increase in kidney disease may be linked to the increase in feline diabetes. Diabetes in fact has a severe negative impact on health in various ways so it's important that caregivers ensure that their cat maintains a healthy weight.

The biggest sign of kidney disease in elderly cat would be drinking a lot more water and urinating more and more often. That's because the kidneys are malfunctioning and not processing the liquid and so it passes straight through them. This means they're more thirsty and so they drink more and then pee more. Watch out for that particular sign as it will pretty well certainly be kidney disease if your cat is elderly. There is no cure the kidney disease and it often leads, sadly, to humane euthanasia.

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P.S. please forgive the occasional typo. These articles are written at breakneck speed using Dragon Dictate. I have to prepare them in around 20 mins.

US Food and Drug Administration approve a drug for cats with anaemia due to kidney disease

Chronic kidney disease may decrease a cat's ability to produce red blood cells which can lead to anaemia. This impairs the cat's ability to transport oxygen around their body. Their gums may appear pale pink or whitish in colour and the disease make them lethargic. It can lead to euthanasia or death.

It's reported that the United States Food and Drug Administration (FDA) has approved a drug to treat this form of anaemia which is caused by chronic kidney disease. The drug is called Varenzin-CA1.

It's been granted a one-year conditional approval. This means it can be used while the FDA finish collecting effectiveness data.

The sponsor of the drug will need to show that it is effective in order to achieve full approval. They will be given for annual renewals to continue with the drug but if the requirements are not met after five years the product will be removed from the market.

I'm told that this is the first drug to receive conditional approval for use in domestic cat. That comes from the FDA.

The disease is called non-regenerative anaemia. It is triggered when the cat's bone marrow does not produce enough red cells to replace older red cells which as mentioned creates an oxygen deficiency.

We know that chronic kidney disease is common in older cats. It is often a cause of death. I'll presume that non-regenerative anaemia is an associated cause of death.

The drug works to increase production of a hormone secreted by the kidneys, erythropoietin, which stimulates bone marrow to produce red blood cells.

It is given orally and was evaluated in a two-phase study on 24 cats aged between 4-17 of different breeds and random bred cats.

It is given once daily for 28 days and it can be given in a second session of 28 days with a minimum seven-day interval. It can be received through prescription by a licensed veterinarian.

Potential side-effects are blood clots, vomiting and increases in systolic blood pressure as reported by the FDA.

Female cat with CKD and hyperthyroidism is vomiting a lot. What's going on?

A person on social media asked for some advice because their cat is vomiting and they are suffering from chronic kidney disease and hyperthyroidism. They are seeing a veterinarian but they wanted to bounce the problem off other social media users one of whom is me. Of course, I strongly advocate seeing a veterinarian and this person has seen a veterinarian about the recent developments and will see them again.

Image: MikeB

This is my brief response:

"I am not a veterinarian but I know cats very well. Your cat has chronic kidney disease. She is vomiting. Is there a link between chronic kidney disease and vomiting? That is the question that comes to my mind.

There is a connection. Signs of uraemia which is toxins in the blood because they are not being eliminated by the kidneys, can result in vomiting, diarrhoea and anaemia.

There are other symptoms. So, it's just possible that the chronic kidney disease may have advanced more than is believed.

That said, the vomiting might not be linked to the kidney disease. Domestic cats vomit very well and competently for a large number of reasons and those reasons might not be associated with her chronic illness.

Has the vet done a urine test for blood urea nitrogen (BUN) and creatinine? I would ask the vet about that asap. 

I don't think vomiting is linked to hyperthyroidism. Hope this helps a bit and the best of luck."

Do any readers of this post have any other thoughts out of interest? 

The link between kidney disease and bad breath in cats

I've just discussed the link between periodontal and kidney disease in cats. There is also a link between kidney disease and bad breath in cats. The same link occurs in humans. Bad breath is sometimes referred to as halitosis. It is due to the excessive amount of urea in the bloodstream when the kidneys are malfunctioning. Kidneys filter out urea. The smell can be like ammonia which is the same smell you pick up when you go into the home of a cat hoarder because the cats have been urinating on the floor due to stress.

Image: MikeB

The link between bad breath and kidney disease is important because kidney disease is very common in domestic cats affecting between about 2% and 20% of all domestic cat but the prevalence is much higher in elderly cats above the age of 15 where it might be as high as 80%.

The information might be useful as a diagnostic tool in trying to work out why your cat has bad breath but there are other reasons obviously such as poor oral health due to reasons other than kidney disease such as bad gum disease and stomatitis, or something stuck in a cat's mouth or throat such as a bone.

Linked page:

• 5 possible reasons why your cat’s tongue is sticking out
• Home treatment for bad breath in cats

The link between gum and kidney disease in cats

There is a link between periodontal disease and kidney disease in cats but, as I type this, I'm not sure what that link is. What I mean is I'm not sure if periodontal disease can cause kidney disease or vice versa. I know that kidney disease can cause bad breath in cats which is ammonia smelling. 

Periodontal disease in cats. Left: Gingivitis. Middle: Teeth cleaning kit. Right: Commercial feline dental food. Image: MikeB

I am researching as I am typing this. It seems that periodontal disease can increase the risk of kidney disease and liver and heart disease. Further, a study in humans, specifically 699 African Americans, showed that periodontal disease can make people more prone to kidney disease. The study found that African-Americans with severe gum disease were over four times more likely to develop chronic kidney disease.

The study also appears to have concluded that if periodontal disease is properly treated and eliminated that has a positive effect on the onset of chronic kidney disease i.e. the onset can be prevented.

Another study discusses an "imbalance of the body's oxygen producing free radicals and its antioxidant cells could be the reason why gum disease and chronic kidney disease affect each other..."

In this study over 700 patients with chronic kidney disease were examined both orally and using full body examinations including blood samples. The aim was to test the hypothesis that periodontal disease and kidney function affect each other. The results show that a 10% increase in gum inflammation reduces kidney function by 3%. And a 3% worsening in kidney function translates to an increase in the risk of kidney failure over a five-year period from 32%-34%. Interestingly, the study found that a 10% reduction in kidney function increases periodontal inflammation by 25%.

The researchers found that the link between gum disease and kidney disease was caused by "oxidative stress" which is a biological process. It is an 'an imbalance between reactive oxygen species and the body's antioxidant capacity which damages tissues on a cellular level'. I have quoted that verbatim by the way because I don't understand it :) !

The study is the first to try and 'quantify the causal effect of periodontitis on kidney function' and vice versa as well as the first to elucidate the pathways involved. They suggest that further studies are carried out. The study was carried out by Dr. Praveen Sharma and team at the Periodontal Research Group, University of Birmingham's School of Dentistry.

An important point I forgot to mention is that 85% of cats have gum disease at 2 years old or later and sometimes at aged one. This shocking stat from my reference book tells me that gum disease may be why kidney disease is too prevalent in domestic cats. Elderly cats often die of it. Perhaps owners should be cleaning their cat's teeth as a default. No exceptions. At the moment it is rare.

Increasing the life of cats from 15 to 30 years - a cure for feline kidney disease

Professor Miyazaki believes that he might be able to double the expected lifespan of domestic cats to 30 years using a treatment he is working on.

Toru Miyazaki, 59, professor at the Graduate School of Medicine of the University of Tokyo. Picture: the University.

His extensive research found a new protein in the blood of humans and animals. He calls it AIM which stands for "apoptosis inhibitor of macrophage". Yes, I know that doesn't help!

He says that feline kidney disease is caused by dead cells piling up in the urinary tract which blocks the passageway like a clogged drain. This leads to kidney damage.

He says that AIM acts as an agent to unclog the pipes. AIM "goes to the problem area through the blood and flags exactly where the waste is. AIM itself does not dissolve the problem cells; rather other cells like macrophages come along to eat them". Macrophages are cells which destroy harmful organisms. They are also described as a "type of white blood cell that eats and digests foreign material inside the body."

He wants to administer AIM to cats via a vaccine as a preventative medicine and perhaps in other ways (orally or in a capsule?). He's started clinical trials in 2020 (reported). He wants the treatment to become a commodity i.e. a useable product by 2022.

My cat died on CKD. Photo: MikeB

He's excited by the possibility of AIM extending the lives of cats dramatically. He's correct in saying that feline kidney disease is a mass killer, shortening the lives of domestic cats in huge numbers.

His work is reactive essentially. I hope that he is successful but what about researching the reason why feline kidney disease is so disastrously prevalent in the domestic cat population? Is it the food? It might be. Why do domestic cats die of kidney far more often than humans? We need to address that question with more vigour.

No one comes up with a satisfactory answer as to why domestic cats are so predisposed to kidney disease. The situation indicates an underlying but as yet unknown environmental reason. My best bet is the commercial foods that we feed them. It might be the dry foods which have gained in popularity tremendously over the past decades.

CKD affects 8+ percent of cats of 10 years old and older. One well-known vet, Dr Elizabeth Hodgkins believes that dry cat foods are the culprit and feeding high quality wet foods can help dramatically plus a powdered phosphorus binder. One cat, Georgia, did very well on "fluids, a phosphate binder and a commercial high-protein diet. Read her book Your Cat to find out more.

Cat owners should also wish the best of luck to the professor in his quest to increase the life of domestic cats from 15 to 30 years.

Most common domestic cat diseases treated under pet insurance policies in America

The most common domestic cat diseases treated under pet insurance policies in America in 2018 were reported as: undiagnosed diarrhoea and vomiting, urinary tract diseases, kidney diseases, gastrointestinal conditions, hyperthyroidism, diabetes, periodontitis and general oral health problems. This information comes from five different pet insurance companies: Trupanion, ASPCA, Pets Best, Nationwide and Embrace. 

You can see a trend there or at least I can. Urinary tract problems including kidney disease are a major issue in domestic cats and also it seems are diseases of the gastrointestinal tract. These would appear to be related to diet because what goes in has to be digested and waste is expelled. Both ends of the food processing channel are affected.

Photo: Pixabay.

I have this feeling that there is something hidden is going on in homes in the West which is affecting the health of domestic cats. The high incidents of kidney disease is unacceptable. And I don't think anything is being done about it. I'm referring to food and the chemicals in the home such as fire retardants and carpet chemicals. These are volatile chemicals which give off fumes and these fumes linger in the atmosphere inside the home. I wonder whether the air quality inside homes is sufficiently good for domestic gas. If it isn't it can't be good for people either but cats are nearer the surfaces.

Cats lie on sofas. If that sofa has a fire retardant inside it then the cat is more likely to absorb these chemicals. The same goes for carpet chemicals. These are examples. And as for cat food, I think we know now that the cheap dry cat food is simply not good enough. A lot of people rely on it because it is cheap and convenient. They allow their cat to graze at any time day or night. Arguably this is overly convenient.

You add to poor quality dry cat food the extended daytime absence of solme human caregivers and you create a slightly toxic world for the domestic cat which can result in urinary tract health problems such as cystitis, a bacterial infection of the bladder, exacerbated by stress.

If there is a high predominance of gastrointestinal diseases causing vomiting and diarrhoea then surely this points to food. Doesn't it? Shouldn't veterinarians be looking at the quality of food provided to domestic cats? Perhaps they don't want to look at it because they want a huge number of cats coming through their doors vomiting and shitting diarrhoea. I am too cynical. One pet insurance company said that they paid out US$9,650 to treat a cat with a gastrointestinal condition.

They also said that they paid out US$40,000 to treat a cat with kidney disease. Do the insurance companies investigate the cause of these diseases? Do they dig around and try and prevent the diseases happening? Do they have a vested interest in doing nothing about these diseases? Do they work together with veterinarians and pet food manufacturers to try and eliminate them? I know there are lots of questions but can you find the answers? I don't think you can. I know that the pet food manufacturers work with veterinarians and this to my mind creates a conflict of interest.

Two pet insurance companies rated diabetes as their third most common cat illness claim. Arguably, feline diabetes, which I presume refers to type II diabetes or sugar diabetes, might be caused by the high carbohydrate content in dry cat food. Dry cat food has to have a high carbohydrate content in order to make it. It is there simply as a manufacturing necessity. Domestic cats don't need this sort of carbohydrate level in their food. It is unnatural to them and it is causing, it is argued, hypoglycaemic cats and overburdening the pancreas which produces insulin. This upsets the insulin/sugar balance in domestic cats which can lead to type II diabetes. This is the argument of a well-known veterinarian in America called Elizabeth M Hodgkins DVM.

I am harping on about cat food. And I do give my cat dry cat food although it is the highest quality I can find. And I also feed him lots of high quality wet cat food. But I am dissatisfied in general with the quality of cat food. It does not reflect accurately enough the perfect domestic cat diet which is the mouse which is 40% protein, 50% fat and only 3% carbohydrates. The average dry cat food for cats contains 35-50% carbohydrate calories according to the catinfo.org website. Do you see the massive difference and how that could impact a cat's metabolism and ability to cope with it?

Feline Excess Urination

A person visiting a major website about the domestic cat said that he was on a fixed retirement income, had not taken his domestic cat to the veterinary surgeon and that his cat was urinating much more than normal and he wondered why. He said that he was going through about 90 lbs of cat litter every month compared to 35 pounds normally and he wanted some advice.

The obvious answer is to take the cat to the vet but it is amazing how often people don't want to do that and they ask questions on the Internet and hope to get a good answer and fix the problem which is highly unlikely, meanwhile his cat is suffering.

One of the feline diseases that causes this is diabetes. The cat does not produce enough insulin. This results in an elevated blood sugar level. In turn, excess glucose is eliminated by the kidneys resulting in frequent urination. As a result, the cat drink more water.

Another disease that causes a cat to drink more water and urinate more often is kidney disease. Both diabetes and kidney disease are fairly commonplace amongst the domestic cat population. And both of these diseases cannot be cured by a cat caretaker. They both require careful handling and a proper diagnosis.

Feline Lower Urinary Tract Disease can result in frequent urination and passing blood. The cat may urinate outside of the litter box.

Increased drinking and urination with very dilute urine may indicate that a cat has Cushing's disease. About 75% of cats with Cushing's disease also have diabetes mellitus. This is not a complete list.

There's no doubt that when a cat is consistently peeing more than normal, as a matter of urgency, the cat's owner should take her/his cat to the vet.

Cat Health And Stress

Reducing a cat's stress as a way of improving health has not been adequately recognised and tackled. Stress reduction is an important part of medical treatment. This is something that is well recognized in people.

Stress can affect a cat's immune response and therefore the cat is more likely to develop a disease. Once infected, stress can prolong the disease. One aspect of a cat's daily life that can cause stress is being forced into close proximity with other cats that the cat does not want to be close to. This can happen in multi-cat households where the person introduces new cats rather than the cats being related. The person chooses the cat's companions rather than the cat choosing them (as happens naturally in feral cat colonies).

Short-term stress increases the hormone cortisol, which does not reduce the effectiveness of the immune system. The problem is long term stress resulting in long term release of hormones such as cortisol and cytokines.

One disease is repeatedly mentioned as being exacerbated or caused by stress: idiopathic feline lower urinary tract disease (e.g. cystitis). "Idiopathic" means arising for an apparently unknown reason. The well discussed "inappropriate elimination" (not using the litter box but going somewhere inappropriate to the human) can be caused by stress.

Stress can also exacerbate disease through a loss of appetite and poor diet.

In places where cats are thrust together such as multi-cat households, catteries, shelters etc. paying attention to "social stress" can have a positive effect on the welfare of the cats. The domestic cat has learned to be a social animal. Many domestic cats are thoroughly in tune with idea of living in groups and socialising. However cats are individuals and some cats will not wish to socialise. These cats might become stressed if forced to socialise for the long term with little means to escape.

When there is an outbreak of a disease in a multi-cat establishment, one long term strategy should be to look at the reduction of stressors through reorganising the social groups and by making environmental changes.

Associated: Stressed Rescued Cats

Signs of Cat UTI (urinary tract infection)

The signs of urinary tract infection or disease are as follows:

1. The normal voiding of urine is disturbed.
2. Excessive urination. This is called "polyuria". Increased urination leads to increased drinking. You will notice both. Make sure fresh water is always available as it goes down faster. A complication is that the signs of diabetes mellitus and hyperthyroidism are similar.
3. No urination. This is called "anuria". Caused by blockage or kidney failure. Toxins obviously build up in the body.
4. Pain accompanies urination. This is called "dysuria". You will notice straining when urinating and no urine sometimes or bloody urine. Possible distended bladder results. Cats might urinate in bath, passing spot of bloody urine.
5. Bloody urine. Called "hematuria". Bloody urine without pain indicates kidney failure.
6. Incontinence (urinating without control). There are a number of causes for this. A vet must diagnose.