Head Tilt and Disorientation in Cats

Idiopathic Vestibular Disease in Cats

Head tilt is a medical condition that may be indicative of a serious underlying disorder, usually of the vestibular system. If a cat is tilting its head frequently to either side of the body (away from its orientation with the trunk and limbs), this is an indication that the cat feels imbalanced. The cat may even struggle to retain a balanced posture and fall.

A common cause of head tilting in cats are disorders of the vestibular system, a sensory system located in the inner ear which provides information needed to hold the body in an upright position and move about confidently. In essence, the vestibular system "tells the body where it is in relation to earth— whether it is upright, up-side-down, moving, being still, etc.

Symptoms and Types

• Abnormal head posture

• Head tilt to either side

• Stumbling, lack of coordination (ataxia)

• Constantly falling over

• Eye movements erratic, apparent inability to focus

• Circling (turning in circles)

• Nausea, vomiting

Causes

Although the underlying cause for vestibular disease is unknown, the following factors may contribute to the condition:

• Ear injury

• Brain disease

• Metabolic diseases

• Neoplasia (abnormal tissue growth)

• Nutritional deficiencies (e.g., thiamine deficiency)

• Toxicity (e.g., use of toxic antibiotics in the ear)

• Inflammation of the central and inner ear canal due to bacterial, parasitic, or other type of infection

Diagnosis

Your veterinarian will perform a complete standard physical exam, including a blood chemical profile, a complete blood count, a urinalysis and an electrolyte panel. You will also need to give a thorough background history of your cat's health leading up to the onset of symptoms. The results of the blood tests are usually normal, though changes may be present depending on whether there is an existing disease, such as an infection. Further tests will be required to diagnose underlying systemic diseases like thyroid problems, and infections.

Nutritional status will be evaluated, and you will need to recount your cat's normal diet, along with supplements or additional foods you may have fed to your cat. Thiamine deficiency, for example, can be the result of feeding your cat food that does not have B1, the source for thiamine, in its ingredients. Thiamine deficiency can also result from over consumption of raw meats and fish.

To determine if an ear infection is present, your veterinarian will thoroughly examine your cat's ear canal and will take a sample of the material present within the ear canal for further testing. Visual diagnostic tools, X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) may be required to confirm a middle ear disease. Another important test used to diagnose this disease is a cerebrospinal fluid (CSF) analysis. (CSF is a clear, watery liquid that surrounds and protects the brain and spinal cord.) The results of a CSF analysis is useful in the diagnosis of inflammation and/or infection within brain. A bone biopsy may also be performed is an advanced test to confirm the involvement of the bone due to tumor or infection.

Treatment

In case of severe disease, your cat may need to be hospitalized for treatment and supportive care. Fluid replacement therapy is required in patients with fluid deficits due to frequent vomiting. These patients don’t require a special diet except in those cases where some nutritional deficiency is present. For example, thiamine supplements are often required in patients with head tilt due to thiamine deficiency.

In some cases, surgery is required to treat the underlying disease. If an ear infection is present, your veterinarian will prescribe broad-spectrum antibiotics that can enter and eradicate the infection in the brain and middle ear.

Living and Management

The prognosis is highly variable depending on the underlying disease. If the head tilt is due to involvement of the ear, chances for complete recovery are fairly high. In some cases, head tilt may persist. You will bring your cat to your veterinarian for regular follow-up examinations. Follow treatment guidelines strictly and give medications at proper doses and time. Incorrectly medicating your animal is one of the most preventable accidents with pets. In addition, do not use any drug of your own, or any drug that has not been approved by your veterinarian, especially in the ear, as it may complicate symptoms further.

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Get to Know Your Dog’s Digestive System

A healthy digestive system is essential to your dog’s well-being. The digestive system serves many important functions: it takes in food, absorbs nutrients, maintains fluid and electrolyte balance, and gets rid of waste.

It also covers a lot of area. The digestive tract includes the oral cavity (salivary glands, tongue, teeth), esophagus, stomach, small and large intestine, liver, pancreas, rectum, and anus.

The canine digestive system isn’t the most glamorous topic, but understanding how it works puts you in a better position to determine if your dog is sick and needs to be seen by a vet. It can also guide you in making decisions that will enhance their health.

Here are 7 interesting facts about your dog's gastrointestinal tract and health!

1. Dogs Get Heartburn, Too

Dogs can get indigestion and heartburn just like humans.

In the fasted state, stomach acids are very similar in people and dogs. After eating, however, dogs produce more acid than we do.

Our similarities mean that dogs and people benefit from the same antacids. But before giving your dog an over-the-counter antacid, talk to your veterinarian. You will want to be sure you aren’t risking any potential drug interactions or side effects.

Veterinarians can also provide you with important usage guidance for antacids to ensure you are not putting your pet’s health at risk.

But more stomach acid doesn’t translate to letting your dog eat potentially contaminated foods. Dogs are no less sensitive to food poisoning (bacterial contamination) than are people. The practice of feeding raw meat to dogs carries a demonstrated risk of food poisoning.

2. Food Moves Through a Dog's GI Tract Three Times as Fast

Dogs have a small intestine that occupies about 25% of the total gastrointestinal volume, which is consistent with other omnivores, including people. The small intestine of a cat, a true carnivore, occupies only 15%.

On average, food moves through the canine stomach a bit slower than ours, but food movement through the intestines is a little faster. Gastrointestinal transit time is six to eight hours for dogs, while in people it’s between 20 and 30 hours.

3. Dogs Can’t Chew Side to Side

You’ve probably noticed that your dog can’t chew side to side. The dog’s jaw only allows for up and down motion when chewing, whereas people have side-to-side movement that allows more grinding of food.

The difference probably has to do with our historical diets. The wolf-like ancestors of dogs ate mostly meat that could be easily ripped and swallowed, but people also relied on gathering or farming plant material that required more chewing.

4. Most Dogs Can Digest and Absorb Carbs

But modern dogs are considered omnivores, just like we are. They originally ate a carnivorous diet in the wild, but since they have been domesticated, adaptions have been made that allow them to digest and utilize plant-based nutrients.

True carnivores, like cats, have a higher nutritional requirement for taurine, arachidonic acid and certain vitamins, which are available in animal fat and protein sources.

Omnivores don’t have a higher requirement for these and create their own arachidonic acid from vegetable oils. Most normal dogs have no difficulty digesting and absorbing carbohydrates. So, there is no benefit to feeding grain-free diets to normal dogs.

5. Cholesterol Doesn’t Impact a Dog’s Health

Your doctor may advise you to lower your cholesterol level, but you won’t hear the same concerns echoed at the vet’s office. Cholesterol does not have the same effect on your dog’s heart, and their digestive systems are designed to accommodate animal fat.

Dogs also don’t have the same issues with colon cancer, so the idea that eating foods high in soluble fiber or low in saturated or trans-fats will provide any health benefit is really unknown at this point.

Vets say one of the keys to health is keeping your dog at a healthy weight. Obesity is related to exacerbation of many health problems in dogs and is a vet’s number one battle. If it’s any one thing that we can do, it’s talk to our vets about how to curb obesity.

6. Diarrhea and Vomiting May Be Bigger Problems Than You Thought

Gastrointestinal diseases account for about 10% of veterinary visits. Diarrhea is one of the most frequent clinical signs. Abnormal stool may also be a first symptom of a more systemic disease process, such as kidney, liver, and some endocrine disorders.

Vomiting is also a common symptom. An acute bout may resolve itself over a day or two—vets will often recommend a short, 12-hour period of fasting to “rest” the GI tract, followed by a bland diet of chicken and rice. But when the clinical signs continue or are especially severe, testing is often recommended to attempt to find out what may be causing the distress.

Imbalances with other organs, such as the kidneys, can also cause gastrointestinal signs. It is important to see your vet to determine the best treatment for your dog.

7. Your Dog’s Poop Tells a Lot About Their Health

You can learn a lot about your dog’s health by studying her poop (an unpleasant, but necessary task).

There are a variety of causes for abnormal stool. Most episodes of acute onset diarrhea are typically self-limiting within a few days, as dietary indiscretions are a frequent cause.

Parasites, bacteria, and viruses may also cause diarrhea. Depending on the underlying cause, the animal may or may not need appropriate treatment for the infectious agent. If diarrhea persists for several days, and/or there is blood in the stool, the animal should be examined by a veterinarian who can determine the most appropriate course of treatment.

On the other hand, if your dog isn’t pooping and is straining to defecate, they may be constipated, which if prolonged, may cause serious health issues.

One important takeaway is to contact your vet if you notice anything suspicious. Even short episodes of diarrhea or constipation that occur periodically, especially in combination with other signs, like weight loss and loss of appetite, may indicate a more complicated disease process.

Another key point is that you regularly monitor your dog’s poop habits. It is important for the owner to daily monitor how often the animal defecates and the consistency of the stool. There is some variation between animals and also variation from day-to-day, with some animals having consistently softer stools or harder stools than others. But generally, with time, the owners should be able to establish what’s normal for their animal.

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Let's talk about cat poop!

Healthy Poop in Cats

How often should a cat 'go'?

The general rule of thumb is that a cat should poop at least once a day. However, the frequency of your cat's bowel movements is affected by multiple factors including the age (i.e. kittens defecate more often than adults), diet, exercise, and health status (i.e. IBD, hyperthyroidism, parasites, CKD).

Because of this, the exact frequency of the bowel movement will be individual, and you should monitor for its fluctuations instead. If your cat's bowel movements start to differ from the normal frequency for longer than a day or two, it is advisable to pay a visit to the vet and resolve the cause of the change.

What does healthy poop look like?

Healthy cat poop should be deep brown in color (but not too dark nor black) and malleable in consistency (similar to modeling clay; it should be firm enough to leave little to no residue on the ground when picked up, yet pliable and not too hard). Poop should be passed in one piece or a few smaller pieces of somewhat cylindrical shape and segmented appearance. The odor shouldn't be too foul, although this can be variable.

Unhealthy Poop in Cats

The key signs to look out for in your cat's poop are the consistency, shape and color. The stool's consistency is directly influenced by the amount of moisture in it, which gives you an insight into the colonic health. The colon (or the large intestine) reabsorbs the remaining water and other key nutrients from the indigestible material, thus solidifying this material into the firm stool. The consistency of the stool can be descriptively scored to help you recognize if your cat's stool is healthy.

A comprehensive fecal scoring guide was described by Purina. According to Purina's guide, the consistency of the healthy stool can be scored on the scale from 1 to 7. The healthy stool (as described above) is scored with 2, while the stool that is too hard and dry is scored with 1. Scores from 3 to 7 are reserved for moist, mushy or liquid stools.

Hard stool (score 1) is typically a sign of constipation, which can be associated with dehydration, colon obstruction or certain metabolic and neurological conditions. Thus, if you notice that your cat is passing poop that is too hard in consistency, you should pay a visit to the vet and address the issue. The hard poop is passed in smaller, more spherical pellets which leave no residue on the ground, and the passing itself requires more effort.

Soft, mushy or liquid stools (scores 3-7) can be a sign of bacterial infections, intestinal parasites, or food intolerance. If your cat's poop is moist on the surface, thus leaving residue on the ground, but retains the shape and form when picked up, then its consistency can be scored with 3. This poop has little to no visible segmentation, but is not considered to be an alarming sign.

If the poop is so moist that it feels saggy and it loses form when picked up (but does retain a logged shape when passed), then the consistency can be scored with 4. Furthermore, if the stool is passed in a pile rather than the logs, then it is scored with 5. If your cat passes liquid stool with texture but no shape, then the consistency is scored with 6. Liquid stool without any texture nor shape is scored with 7.

Soft or fluid stool (as described by the scores 4-7), accompanied by a more frequent bowel movement, are referred to as diarrhea. While the causes for diarrhea are variable and often multi-factorial, this state is considered to be an important, sign of underlying problems and is a legitimate reason to consult with your vet. Sometimes, diarrhea can be caused by stress (i.e. moving to a new environment or bringing in a new pet), or food allergies and intolerance.

Other times, however, diarrhea can be a symptom of a disease, a bacterial infection, or even intestinal parasites. If your cat is suffering from diarrhea, make sure to closely monitor the frequency on your cat's bowel movement, so you can report it to your veterinarian. Keep an eye on other signs of disease and injury and the changes in your cat's behavior. This will be key for the diagnosis of the underlying cause.

Contact your veterinarian ASAP after spotting the symptoms, especially if diarrhea persists for more than two days and is accompanied by lack of appetite, lethargy, or vomiting. The veterinarian will diagnose the underlying cause and help you design a special recovery diet for your cat until it recovers.

The stool is a direct insight into its colonic health. It can help you recognize if your cat is eating the right diet and drinking enough water or if it's suffering from certain health problems. So, the next time you clean the litter box, make sure to quickly inspect if your cat's poop is healthy! A healthy cat is a happy cat.

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Possible Causes for Your Cat Vomiting Clear Liquid

Vomiting is not normal in cats, and when your cat vomits clear liquid, it can be a sign of a serious illness. Vomiting itself is what is considered to be a nonspecific symptom. It could be associated with an array of health concerns. Some of these can include things like hairballs, internal obstructions, pancreatitis, eating too quickly, constipation, indigestion, parasitic infections, poisoning, stress, depression, or even anxiety.

Possible Causes for Your Cat Vomiting Clear Liquid

Hairballs

Cats are naturally meticulously clean animals and groom themselves for a large part of their day. As your cat grooms themselves, tiny hook-like structures on their tongue catch loose and dead hair, which is then swallowed. The majority of the hair passes all the way through the digestive tract with no problems, but sometimes the hair stays in the stomach and forms a hairball.

Commonly, cats will vomit up clear liquid prior to a hairball. Although, a cat vomiting up clear liquid with a hairball occasionally can be normal and not a concern, it is important to note that hairballs should not be frequent, painful, or difficult for your cat to pass. Some commercial cat diets and treats are formulated to help prevent formation of hairballs. Adopting a regular brushing schedule and getting your cat comfortable with brushing can also help get rid of any loose fur in your cat's coat that they may otherwise ingest when grooming themselves.

Food and Dietary Changes

When there is a change in your cats feeding schedule, if your cat misses a meal or eats later than normal, your cat may vomit up clear liquid.

In addition, you may have switched your cat’s food too quickly. When changing your cat to a new diet, it is recommended to do it gradually over a one to two-week period gradually decreasing the amount of current cat food while increasing the amount of new cat food.

Your cat may eat too quickly, and this can cause clear vomit or clear vomit with food present. If you cat is a habitual 'scarf and barf' cat or if they have intestinal sensitivities, that may be causing them to vomit up partially digested or undigested food. If your vet has ruled out other medical issues and thinks that what your cat is vomiting up is actually food, they may want you to try a food for sensitive stomachs with your cat. If your cat is still struggling with vomiting food on this special diet, they may then want to put your cat on a strict, hydrolyzed protein diet.

Your vet may also suggest food puzzles for your cat. Food puzzles are a great source of both play and enrichment for your cat. There are more and more manufactured food puzzles available on the market that stimulate both of your cat's predatory and foraging instincts. The added benefit of food puzzles for a cat that chronically vomits their food, though, is that it slows down the chow time so that a cat cannot eat too quickly and then get sick from it.

Indigestion

Just like in people, a cat's stomach produces various gastric juices as well as hydrochloric acid to digest their food. If, however, a cat skips a meal for some reason, or if they are not fed on time, that buildup of juice and acid can irritate the stomach and cause your cat to vomit. Cats with indigestion may vomit yellow foam in addition to white foam. If you and your vet suspect your cat's vomiting is from indigestion, your vet may suggest feeding small, frequent meals at the same time throughout the day so as to alleviate any buildup of stomach acid.

Gastritis

If your cat is one to get into things they shouldn't, it is possible that they have irritated their stomach with something that they have eaten. When this happens, you may see vomiting clear liquid in addition to vomiting blood and/or bile. Your cat may also be exhibiting a decrease in appetite, a depressed attitude, lethargy, or dehydration. Your vet will know just what to do if your cat is vomiting because of gastritis.

Some other causes can include:

• Parasites

• Constipation

• An obstruction of foreign material in the intestinal tract

• Ingesting a toxin

• Metabolic disorders such as diabetes, kidney disease, and hyperthyroidism

What Should I Do if My Cat Is Vomiting Clear Liquid?

Some cat owners may describe their cat as 'puke-y' but it should be noted that frequent vomiting is never normal for a cat. Vomiting more than once a week is definitely a sign of issues. If your cat is vomiting clear liquid several times and/or in conjunction with other symptoms such as lack of appetite, weight loss, lethargy, or diarrhea, you should make an appointment with your vet right away. Your vet will want to start with a physical exam, checking your cat's vital signs and palpating your cat's abdomen. After a thorough examination, your vet may also want to run some tests, including blood work and x-rays. Blood work will check your cat's organ function, making sure that there are no signs of liver disease or kidney disease, as well as your cat's red blood cell and platelet levels. An x-ray study will check for any fluid in the abdomen that could potentially be blood and it may also show intestinal gas patterns that could be indicative of a blockage.

Depending on what your doctor finds, your cat may require hospitalization for fluid therapy and supportive care, or they may just need outpatient treatments and oral medications to go home on. If your vet suspects your cat has an intestinal blockage your cat may require surgery to remove whatever the blockage is.

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Diabetes Ketoacidosis (DKA) - A Complication of Diabetes in Cats and Dogs

Unfortunately, as veterinarians, we are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). You're probably wondering if you just had a dog or cat diagnosed with diabetes mellitus—what do you do? First, we encourage you to take a look at these articles for an explanation of the disease:

• Diabetes in Cats

• Diabetes in Dogs

This article will teach you about life-threatening complications that can occur as a result of the disease; specifically, a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it.

What is DKA?

When diabetes goes undiagnosed or difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells — resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body.

Symptoms of DKA

Clinical signs of DKA include the following:

• Weakness

• Not moving (in cats, hanging out by the water bowl)

• Not eating or complete anorexia

• Vomiting

• Excessive thirst and urination (clear, dilute urine)

• Large urinary clumps in the litter box (anything bigger than a tennis ball is abnormal)

• Weight loss (most commonly over the back), despite an overweight body condition

• Obesity

• Flaky skin coat

• Excessively dry or oily skin coat

• Abnormal breath (typically a sweet “ketotic” odor)

• Diarrhea
  

In severe cases DKA can also result in more significant signs:

• Abnormal breathing pattern

• Jaundice

• Abdominal pain (sometimes due to the secondary problem of pancreatitis)

• Tremors or seizures

• Coma

• Death

What can cause DKA?

When DKA occurs, it’s often triggered by an underlying medical problem such as an infection or metabolic (organ) problem. Some common problems that we see with DKA include the following:

• Pancreatitis

• Urinary tract infection

• Chronic kidney failure

• Endocrine diseases (e.g., hyperadrenocorticism [when the body makes too much steroid], or hyperthyroidism [an overactive thyroid gland])

• Lung disease (such as pneumonia)

• Heart disease (such as congestive heart failure)

• Liver disease (such as fatty changes to the liver)

• Cancer

Diagnosing DKA

While diagnosing DKA is simple, by looking at the blood sugar levels of dogs and cats and by measuring the presence of these fat breakdown products in the urine or blood, treatment can be costly (running between $3-5000). A battery of tests and diagnostics need to be performed, to look for underlying problems listed above, and treatment typically requires aggressive therapy and 24/7 hospitalization.

Treatment of DKA

Treatment, typically, is required for 3-7 days, and includes the following:

• A special intravenous catheter called a “central line” (placed to aid in frequent blood draws)

• Aggressive intravenous fluids

• Electrolyte supplementation and monitoring

• Blood sugar monitoring

• A fast acting or ultra fast acting insulin, regular or Lispro, typically given intravenously or in the muscle

• Blood pressure monitoring

• Nutritional support (often in the form of a temporary feeding tube)

• Anti-vomiting or anti-nausea medication

• Antibiotics

• Long-term blood sugar monitoring and a transition to a longer-acting insulin

Thankfully, with aggressive supportive care, many patients with DKA do well as long as pet parents are prepared for the long-term commitment (including twice-a-day insulin, frequent veterinary visits to monitor the blood sugar, and the ongoing costs of insulin, syringes, etc.).

Preventing DKA

By following your veterinarian’s guidelines and recommendations you can help regulate and control your pet’s diabetic state better and monitor your pet carefully for clinical signs. For example, if your pet is still excessively thirsty or urinating frequently despite insulin therapy, they are likely poorly controlled and need an adjustment of their insulin dose (of course, never adjust your pet’s insulin or medications without consulting your veterinarian).

When in doubt remember that the sooner you detect a problem in your dog or cat, the less expensive that problem is to treat. If you notice any clinical signs of diabetes mellitus or DKA, seek immediate veterinary attention. Most importantly, blood glucose curves (when a veterinarian measures your pet’s response to their insulin level) often need to be done multiple times per year (especially in the beginning stages of diabetes mellitus).

If you have any questions or concerns, you should always visit or call your veterinarian.

Related reading:

• Diabetes in Cats

• Diabetes in Dogs

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