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Stefano Fontana

What Goes In Must Come Out – the Concern About Constipation

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I just want to talk a bit about a condition that can be quite serious in cats.  We take so much for granted in life.  Eating, sleeping and going to the bathroom.  All animals require these things for survival.  What many pet owners do not realize is just how serious it can be if your cat is not passing stool on a daily basis.  

“….. but Doc, my cat isn’t constipated, he/she goes every 2-3 days….”

As your pets’ healthcare provider we become concerned if your cat is not passing bowel movements every 24-36 hours.  If there is a longer time span present then there may be an issue that can lead to an actual blockage of the colon from impacted stool or ‘mega-colon’. 

Why does this happen?

The most common reasons are:

1 – obesity – the presence of excess fat in the abdominal cavity can have numerous consequences and decreased ‘motility’ or gut movement is one

2 – dehydration – many cats do not drink enough water to start with and have a tendency towards dehydration.  There are medical conditions that will predispose them to this issue too:  chronic kidney disease (renal failure), diabetes and hyperthyroidism

3 – decreased GI motility – the intestinal tract is a long, muscular tube.  If the muscles do not contract properly, food/digesta/stool is not moved properly through the gut.  The colon is the area of the GI tract where the majority of water is reabsorbed from the digesta (food) and is where the the stool becomes formed into fecal balls.  

Some patients have an injury in their lower back or pelvis that affects the size of the opening and/or the nerves responsible for getting the muscles to work, others are born with an abnormality in their spine (Manx tail cats or others with abnormal tail formation that my predispose them to this issue) others develop this issue with no obvious cause present.  

4 – musculo skeletal pain – usually ‘arthritis’.  If your pet has any previous injuries or arthritis in the hips or stifles (‘knees’) then he/she may find posturing to pass a bowel movement painful.  It may also be painful for them to contract or try to ‘push’ the stool out.  For these patients it is extremely important that the stool does not become hard, that it remains ‘spongy’ or soft enough that when they push there is little to no resistance to it exiting. 

5 – fur embedded stool (hairball in the colon) – if your cat has been grooming excessively and ingesting more fur, it may ‘pass’ in the stool versus you seeing a hairball being brought up.  However, that fur embedded stool will not have much ‘give’ to it if your cat has to push and strain to pass it out as the fur centre is quite firm and unyielding.  You may not actually see the fur that is there unless you (with a pair of gloves on I hope!) break apart the stool sections to see what is in the middle.  Typically these segments are coated with ‘normal stool’ so visually the outside looks normal. 

The longer that stool sits in the colon, the more water is reabsorbed and the harder and larger the stool becomes making it even more difficult to pass. 

It is fairly common for some of these patients to occasionally eliminate outside the litterpan.  It may be that they need to ‘move’ in order to help them push the problem stool out.  In other cases, it may relate to gut cramping. 

If your cat will safely let you look at their belly, check to see if there are bald patches or areas where the fur is shorter.  If so, this may be due to pain from gut cramping associated with constipation.  Other causes for barbering that area include pain from other conditions such as urinary issues and ‘itch’ such as may be experienced with an allergy flare or full anal glands. 

So what do we do for these patients?  

The answer to that will depend on what your veterinarian finds on physical examination and radiographs of the area.  Bloodwork is also recommended to screen for those medical conditions that can contribute to dehydration and constipation.   

If I see an acute case – a cat who has not passed any stool for a number of days, who’s colon is full of formed, oversized stool on x-rays and who may also be unable to eat +/- vomiting, I will most likely administer a ‘high enema’ to lavage and soften the stool and start this patient on some oral medications.  I may recommend a general anesthetic and a ‘colonic cleansing’ if the cat has not passed stool within a specified period of time (depending on what I have seen on the x-rays and felt on palpation of the abdomen.  This is every bit as unappealing as it sounds.  So if we can avoid having to go there that is best.  There are a few patients that I will see that we have to go to this more intense therapy at the beginning.  And a very unlucky few who may require actual surgery to remove the blockage.    “Repeat offenders” who suffer from mega-colon may require surgical removal of the colon – a drastic measure for sure, but one that can be life-saving if we cannot manage them medically. 

“But why can’t you just give my cat an enema without taking the xray first?”  Because the enema will cause gut cramping and make your cat strain.  If your pet has a blockage higher up in the GI tract that is the issue and he/she strains against it a fatal perforation of the intestinal tract could happen.  This is why it is important to take an xray and make sure that there is not some other issue complicating the situation.

There are a number of ‘management’ tools at our disposal.  These will be discussed with you by your veterinarian.  A special diet and/or stool softeners may be prescribed.  Some patients require GI motility drugs to stimulate the muscles in their colon to contract thus aiding in proper elimination.   Addressing any underlying source of dehydration is important.  Frequent brushing to remove loose fur if your cat has fur embedded stool along with addressing any ‘itch’ or ‘pain’ component to possible over grooming.  Hairball laxatives may be used in some cases if applicable.   Please do not start your pet on a laxative or stool softener without first consulting your veterinarian as cats are not small humans and some drugs that are safe for humans are not for cats and for those that may be safe, they may need to be given at much different doses.  

All too often I have seen people post questions about an issue they are having with their pet on their facebook page.  Numerous helpful replies get posted by well-meaning friends, but the suggestions are not always appropriate and in some cases are outright dangerous for your pet.   Please remember the best source for healthcare advice for your furry family is your veterinarian. 


Note the ‘bald belly’ on this guy! Not going anywhere: This cat gives its owner a scathing look - perhaps the owner suggested some exercise

Until We Meet Again….

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It is with a sad and heavy heart that I inform all of our friends, that we said farewell to Danny this morning.  Words cannot begin to describe this wonderful, quirky cat.

Danny came to us in 2014, as a rescue from Cape Breton, who had multiple medical issues.  He immediately had us all under his spell and we made our clinic his home.

Since that time, Danny has acted as our ambassador, greeter, emotional counsellor and reminder of all the good things in life.  As any good Cape Bretoner would, Danny placed a high value on his friendships, communication and of course, good food.  Ever the social butterfly, he was always quick to give hugs and love to any and all who walked through our doorway.

This morning it became evident that his quality of life was suffering.  Although we did not want to say goodbye, it is always too soon, we knew that to prolong his time here would have been a selfish act.  Danny was surrounded by his ACH family at the end and passed peacefully to “the other side…”

As many of you rknow, Danny had a special love for Sandy, our receptionist.  He would often wait at the door, looking down the hall for her approach.  It was obvious that she gave the best cuddles of all.  Visit our facebook page to see  a photo of the two of them, a beautiful tribute to the human-animal bond!

…..   Until We Meet Again My Friend                                    

~ Dr. Julia


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This is a life threatening emergency in cats that is most commonly seen in males, but can also occur in females.  If you notice ANY of the following signs in your cat he/she may be blocked or becoming blocked:

1 – your cat is in and out of the litterpan frequently

2 – urine spotting on furniture, you, the floor or urinating outside the litterpan

3 – straining to urinate and/or vocalizing when trying to do so

4 – producing small amounts or no urine when voiding

5 – blood in the urine or blood spots around the house

6 – excessive licking of the urogenital area

7 – vomiting, decreased appetite, lethargy, hiding

There are other conditions that can have similar symptoms including, but not limited to:

urinary tract infection, feline interstitial cystitis (FIC) – a stress driven inflammation in the bladder, and more, but for the moment we are focusing on obstruction or blockages….

What IS a “urethral obstruction”?

The urethra is a muscular tube that allows us to empty or void urine.  It connects the bladder to our outer opening.  In females this is a very short tube, in males it is longer and has greater risk of being blocked.  If this tube becomes blocked for any of the reasons below, urine will not be able to pass out of the bladder leading to the bladder becoming very full and stretched.  Urine is unable to pass from the kidneys.  Substances build up in the blood stream and the bladder is at risk of rupturing and the patient at risk of kidney failure and death from toxicity, electrolyte imbalances and from the bladder actually rupturing.  This is not something that your cat will ‘get over on their own’.  It is a life threatening and urgent emergency!

Most commonly one of two things may happen, sometimes both…

1 – if there is a source of chronic inflammation that muscular tube (urethra) can become very irritated and may spasm, like a “charlie-horse” cramp – closing down and unable to relax so urine cannot pass out of the bladder.

2 – the presence of crystals in the urine is extremely irritating to the lining of the bladder and the urethra – acting like razor blades that cut and scrape the area.  These crystals may form a “plug” of crystals or a small  ‘stone’ that blocks the outflow of urine from the bladder.  Some patients become blocked by mucous plugs that develop secondary to all of the irritation and inflammation in the urethra. 

Less commonly but still occurs:

1 – bladder stones may block the outflow of the bladder to the urethra. They may move at times acting like a “stop cock” and only temporarily block the outflow although if small enough they may become lodged in the urethra as described above.

2 – bladder tumors do occur in older cats although they are not common.  These may become large enough to block the flow of urine out of the baldder.

3 – neurogenic issues – damage to the nerves that control the emptying of the bladder can lead to patients being unable to void normally.

Not all obstructions are “total” – in some cases a bit of urine is still passing.  Any male cat with crystals present in the urine is at great risk of potentially becoming ‘blocked” until those crystals are dissolved or passed out in the urine.  The treatment for these cases will be based on the individual patient and a discussion with your veterinarian.  Pain medication, muscle relaxants and if indicated, antibiotics, may be prescribed. All of these cats though will need to be on a veterinary diet to dissolve any struvite crystals that are present and to limit the further formation of struvite or calcium oxalate crystals.  It is important to realize that there is no grocery store or pet food store diet that will do this. 

Your veterinarian will want to perform a urinalysis and ideally take screening xrays for stones or other abnormalities.  Please be aware, crystals and stones may be present but may not be seen on the urinalysis, this is why screening xrays are very helpful. Mineralization in the kidneys, ureters and/or bladder may be seen on screening xrays.

Crystals will tend to ‘settle’ to the lowest point of the bladder and may not be floating freely in the urine when the sample is collected.  I have seen it happen before, to myself and to numerous other veterinarians who get one sample with no crystals present and then a later sample where they are present in large numbers. This is why your veterinarian will likely recommend the special diet for your cat even if crystals were not seen, especially if a male cat.  

With the development of antibiotic resistance it is very important to perform that urinalysis to ensure that if an infection is present antibiotics are dispensed versus dispensing them without having diagnosed the presence of an infection.  

There may be other important clues in that urine – high glucose indicating diabetes, low concentration that may indicate decreased kidney function, abnormal cells and more. 

If your cat did block or had crystals present you will need to watch your cat’s total urine output over a 24 hour period closely for the next 3-6 weeks and should be monitoring on a daily basis long term to catch repeat occurrences early.  

What causes crystals in the urine?

The two types of crystals commonly seen in cat urine are struvites and calcium oxalates. There are others, but those are not often seen and if found in your cats’ urine may indicate that additional diagnostics should be done to check organ function.  We can dissolve struvite crystals with a special diet and we can limit further struvite and calcium oxalate crystal formation with those same diets.  Calcium oxalate crystals will not dissolve though and have to be passed out in the urine.  Any cat with these present will be at risk of blocking until those crystals present are voided and no further ones are being formed. 

Diet is the main consideration although this can be an inherent issue to the individual – if your cat has made crystals in the urine once, they are at a much greater risk of doing so again, especially if they go back to a non-urinary formula.  Some breeds are more prone to making crystals than others.  High calcium diets can be a risk factor too – so this is something to consider if feeding a very high protein diet that has more bone present in it. 

The concentration of the urine, the pH of the urine and mineral substrate present are all factors in crystal formation and precipitation in the urine. This is why your veterinarian will advise trying to get your cat to eat the canned version, but some won’t.  For those kitties the dried will decrease the pH which drives struvite crystal formation and help to dissolve them so they pass without incident in the urine.  Ideally though, we want to increase their water intake so their urine might not be as concentrated and also to lower the pH to a level where struvite crystals will dissolve and not form.

Bottom Line:  If in Doubt – Get it Checked Out!

Ho! Ho! HOLD the Tinsel!!

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The Holiday Season is upon us and with it all of the decorating and celebrating that so many enjoy.  Be sure to keep your holiday Pet Safe this year.  

Here is a link to a great article about pet safety over the Holidays provided by the ASPCA.

Remember that cats love to play and chew on things and once they start to swallow something long it will keep stimulating them to swallow, i. e. ribbon or tinsel.  Dogs will often investigate and taste snacks left out.  Many cats will too.  Nuts can be fatal to cats if swallowed – only Macadamia nuts are toxic, but almonds and similar sized nuts can cause a fatal blockage of their intestinal tract – be sure to keep these out of reach and pick any up off the floor that spill!

From all of us at the Atlantic Cat Hospital – here is wishing you and your pets a Safe and Happy Holiday Season!

~ Dr. Julia

Tick Season and Lyme’s Disease

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It is that season again folks and very important to be ‘aware’ and vigilant.

I contracted Lyme’s from a tick bite last summer, out in the Shubenacadie area. Coming from a tick infested area (South Carolina) I have always been diligent about checking. I found the tick early, removed her with a tick twister to avoid having her regurgitate, but still developed the classic Bull’s Eye rash 4 days later and immediately went to the doctor and was put on antibiotics. No issues since. Early detection is key. While the information out there says the tick has to be attached for 24 hours and engorged, I will tell you this one was not, on for less than 24 hours and was not engorged, but was embedded.

While most cats will remove ticks through grooming before they attach, we do still see some with infestations. Unfortunately there are very few, safe products available for cats. Please talk to your veterinarian if your kitty goes outdoors and is at risk. You are much more likely to have an issue if you have a dog in your home. There are newer tick and flea control options available for dogs now from your veterinarian including a chewable tablet in addition to the topical spot-ons. Please talk to them to find out what method is best for your specific situation and risk level.

If you live in an area with ticks some tips that may help limit them infesting your yard include creating a barrier of gravel around your yard as they do not  crawl across gravel. (this won’t work if you have trees overhanging the barrier)  Keep your grass mown as tall grass is a hiding spot for them.  If you have trees be aware that they do like to drop from overhanging limbs onto people and animals moving below them.  Perform a ‘tick check’ whenever you come inside from the ‘great outdoors’.  They like to hide in warm, dark spots.  Be sure to check behind your ears.     Check your pets when they come in from outside and if they do go outdoors in a ‘tick area’ include tick preventative/treatment.  Be aware that the ticks on your pets will not die ‘instantly’ with those products and may still drop off of your pet if not attached and seek another host.  There are more useful tips in the article below.…

Sugar and Spice might not be Nice…. Diabetes and Cats

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I am always concerned when an owner tells me their cat “drinks and urinates well” as this can be a ‘red flag’ that there is an underlying medical issue.  The most common causes in older cats are kidney failure, hyperthyroidism, diabetes or an infection in the urinary system.  Younger cats are more prone to urinary tract infections and/or crystals in the urine causing this although we do still see some with kidney failure or diabetes.   Less commonly, liver issues may cause these symptoms. It is possible for more than one of the above issues to be happening at the same time as diabetes leaves them immune compromised and more prone to infections.

As a species, cats were not designed to eat foods high in carbohydrates (sugars) and ALL dry formulas are, as are many canned ones.  Carbohydrates are necessary for the extrusion process to make the dry kibble which is why dry formulas are so high. Many owners are surpised to also find out that dry food is more processed than canned food. The canned food has a higher water content which is beneficial for cats and their kidneys. If on a dry diet, you will usually see them drink more due to the lack of water content in the food.

If you average cat (8-12 lbs or 3.5 – 5.5 kg) is urinating more than two fist sized clumps in the litterpan in 24 hours I recommend having them checked out.  Some healthy/normal cats will produce more than this, but it is a good idea to get them in, check their blood glucose and kidney values and have their urine examined to ensure they are concentrating it, that there is no glucose in it and no infection present.

If diabetes is present and remains unregulated it can lead to many debilitating issues some of which include chronic urinary tract infections, neuropathy that typically affects the way they stand on their hind feet (drop-hocked or flat footed), decreased energy and diabetic ketoacidosis, a lifethreatening emergency.  

Here is a link to a video on our Facebook page of a cat with diabetic neuropathy affecting the hind feet:

If diabetes is caught early your cat has a good chance of going into remission, sometimes with a diet change alone.  The longer it goes unchecked the less likely this will happen.

For more information on diabetes in cats visit:

You may have to copy and paste the links into your browser….

Feline Immunodeficiency Virus (FIV)

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No owner wants to find out that their cat has tested positive for Feline Immunodeficiency Virus (FIV) and/or Feline Leukemia Virus (FeLV).  Today we’re going to discuss FIV.  

While this virus is contagious, it does not live long outside of the hosts body and is typically transmitted through deep bite wounds.  It is important to realize that the transmission rate is low in multicat households as long as there is no fighting (bite wounds).  

It is important for owners to realize that having FIV is not an immediate death sentence for your cat.  However, you do have to be very proactive about their healthcare as you would with any immune-compromised individual.  

Having a cat-only practice we have numerous long-time patients who are FIV positive and are enjoying or have enjoyed, long healthy lives.  Some have passed on due to other old-age related diseases in their mid-teens.  Others have gone on to develop cancers in their adult or early senior years. If very ill at the time of diagnosis, being aware of the impact this disease can have on treatment and prognosis is important in making any treatment decisions.  

Below you will find links to the American Association of Feline Practitioner’s webite

You will need to copy and paste these links into your browser:

you will find more information specifically targeted towards retroviruses (the kind of virus FIV and FeLV are) and their management.

A summary:…

and their full guidelines:…

Visit our Facebook page for a link to another article regarding FIV cats: