by Barry B.Burtis. D.V.M.
Bart had always been a big cat. At his heaviest, he tipped the scales at just over 7 kilograms. Bart had been a street warrior in his youth and his size had likely been an advantage. He had seen the light, though, and perhaps realizing the hard, usually short life of a wandering tom, he had made the wise decision to move in with his people when the opportunity was offered. That was now just over 12 years ago. No doubt about it, Bart was a teenager. He had lived a good life. Regular meals, a roof over his head, good health care, all courtesy of the folks he lived with and who thought Bart was the best.
On his most recent visit to the veterinarian, for his regular checkup, it was noted that he had lost just over a kilogram in body weight since his last visit. That amount of weight loss is more than one would expect, just as a result of aging. Moreover, his resting heart rate was 225 beats per minute, higher than normal, and an enlarged thyroid gland could be palpated in his neck below his throat. The diagnosis of Bart's problem was not difficult. A blood sample collected at the time of his visit was submitted for a geriatric profile. Very significant T4 elevation, one of his thyroid hormones, proved Bart had hyperthyroidism. Fortunately, the rest of his blood tests and analysis of his urine showed no evidence of other health problems. Furthermore, ultrasound imaging of his abdomen was normal. One of three treatment options - oral medication, radio iodine treatment or surgical removal of the thyroid gland - should be able to successfully resolve the disease. However, there was one more diagnostic procedure that Bart's veterinarian wanted him to have done before treatment would begin.
Nigel is a ten year old, male, neutered, Shetland sheepdog. His abundant, tri-colour haircoat, always kept well brushed by his devoted owners, is quite stunning. Nigel is alert, gentle and intelligent. All three traits are very common, in my opinion, in Shelties. Nigel is always affectionate and responsive to his owners. Whenever he visits the animal hospital he is a bit reserved but never nervous or unfriendly to his health care providers.
Nigel was brought to the animal hospital most recently because he always seemed to be thirsty, drinking much more than his usual amount of water. Also, his housetraining, never a problem since puppyhood, had gone out the window. Urine accidents in the house had become commonplace despite letting him out in the yard more frequently. The veterinarian gave Nigel a thorough general physical examination. Nigel had lost a small amount of weight since his last visit but otherwise everything checked out fine. Once again, though, just as with Bart, blood and urine tests provided some answers. Nigel's urea and creatinine blood levels were significantly above normal. He showed signs of anemia and his body was not attempting to increase the reduced number of circulating red blood cells, as it should have been. His urine was very dilute, proven by its very low specific gravity. His kidneys were not concentrating the urine as they should. A diagnosis of chronic kidney failure was made. Once again, however, despite all the blood and urine tests completed, there was one more diagnostic test that Nigel needed.
Rusty is a six year old, neutered male, ginger and white coloured, domestic short hair cat. He has been an active, robust and healthy feline ever since he was adopted from the animal shelter as a seven week old kitten. When the veterinarian listened to Rusty's chest with a stethoscope, recently, as part of a routine examination there were changes from normal. A gallop rhythm and a heart murmur were detected. Neither of these findings had ever been noticed when Rusty was examined previously. His owners were happy to agree with the further cardiac workup recommended for Rusty. Blood tests were normal. Chest x-rays showed no abnormalities. An electrocardiogram showed mild changes in the heart rate but it was the echocardiogram or ultrasound examination of the heart that was diagnostic. Rusty had developed hypertrophic cardiomyopathy. This form of heart disease has been reported in cats between 3 months and 17 years of age but cats in their middle years, aged 5-7 years, are commonly affected. There appears to be familial tendencies for the disease in Maine coon cats, American shorthairs and Persians. Well, you've probably guessed it. Despite all the heart tests Rusty had received, when the diagnosis was made, there was one more test he needed to have done. Treatment would then begin.
Alright, the extra diagnostic test that Bart, Nigel and Rusty all needed is the same one despite the very different nature of their health problem. Each patient needed to have their blood pressure checked. For Rusty it will be important to make sure that hypertension or high blood pressure is not the cause or contributing factor for his heart disease. Nigel needs to have his blood pressure checked because high blood pressure is a common complication for patients who have chronic kidney disease. Control of this problem, if present, can increase both the quality and quantity of life for affected patients. Finally, for Bart and other cats with hyperthyroidism, blood pressure is measured to complete pre-treatment assessment and to properly monitor his health status.