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Interesting Questions

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VAS - Injection Site Sarcoma

The following comment recently came into this website. It is followed by Dr. Deutsch's response.

A work colleague of mine, Stephanie Furtig, referred me to your web site. Our 10-year old female, spayed, indoor-only Ragdoll cat, "Mouse", recently acquired VAS from her state-mandated rabies vaccine. The vaccine manufacturer was Merial. We have filed adverse event forms with FDA and USDA and Merial has "settled" with us for $500 - about one third of what we have spent on our cat for the diagnois and initial surgery to remove the sarcoma. That surgery was unsuccessful, and the sarcoma has returned. We have made the agonizing decision to let nature take it's course and to let our cat live out the rest of her now significantly shortened life span with her dignity and all four of her legs. We live in Maryland, where the state laws are similar to those of VA, but we are lobbying our state representatives to 1) change the vaccination laws to allow responsible pet owners to vaccinate their animals according to the pet's lifestyle (our cats have NEVER been outdoors)!, and 2) encourage supporting the veterinary medicine manufacturers to create safer vaccines and study ways to combat VAS that are more successful than radiation therapy and less drastic than limb amputation. I am curious to know your thoughts on the management and treatment of VAS. Thank you.

The Response

VAS has a better term. Injection site sarcomas. The cancer can be caused by any injection. The cat must have a susceptible genetic make up for the cancer to occur. We changed to intranasal FVRCP vaccines 12 years ago to avoid any unnecessary injection. The main culprits are vaccines that contain adjuvants. These are chemicals that allow killed virus vaccines to stimulate the immune system better. The ONLY non-adjuvanated rabies vaccine on the market is called PUREVAX®. It too is a Merial product. The unfortunate thing is that it is only approved as a one year vaccine. We switched to this vaccine 4 years ago after seeing 3 cats in one year with sarcomas.

You will have zero luck in changing the laws. The politically elected officials that are in charge of these archaic laws are in my opinion under qualified to make these judgments.

No animal has ever been diagnosed with rabies after having received at least 2 vaccines in its lifetime. There needs to be a grass roots effort on the part of the pet owning public to correct the problem. My thoughts are that it could be accomplished with the following actions: Get a competent researcher to agree to conduct the study that shows that 2 vaccinations with Purevax® at a 1 year interval will immunize cats for life. Try Cornell University’s Feline Health Center for starters, and if you get nowhere, keep trying every vet school in the country. If that fails, try the USDA in Beltsville, Maryland, or the National Institute of Health. Get a location to do the study. PETA will be against it because you must house a large number of cats for their entire lives in a controlled environment, but if it spares other cats from this horrible cancer, I believe it is worth it. Get the money. This could be accomplished by having the pet food manufacturers put a coupon on every bag or case of cat or dog food with the promotion of “Please help us stop the unnecessary vaccination of our pets!! If 10 million pet owners send just one dollar each, we can fund the study that will prove that these repeated rabies vaccinations are unnecessary and dangerous to our pets.”

I have 2 small children and a business to run, so I do not have the time needed to dedicate to this effort. I applaud you if you are willing to take this on. I will agree to act as a consultant for you if you take on this project. If you choose not to take it on, many more cats will suffer the fate that your cat is now immersed in.

At our clinic we never use adjuvanated vaccines in cats. We do not vaccinate for Feline Leukemia Virus, as almost all the FeLV vaccines are adjuvanated, and 99.99% of my patients are at zero risk of acquiring the infection.

We only use PUREVAX® for feline rabies vaccination.

Regards,
Dr. Deutsch

Cat Litter Boxes

I am the "Mom" of your patients Sasha and Suzy (photos below).  Here is my question: Are some kinds of cat litter better (for the cats) than others?  Aside from health issues, what other factors should be considered when choosing a type of cat litter?   Thanks so much for your wonderful clinic, and also for your very informative and fun website! Linda

Thank you so much for your thoughtful question! I hope many of our readers will benefit from the answer, and thanks for the beautiful photos of Sasha and Suzy!

Suzy and Sasha

The easy answer is "it depends on what the cat likes." Having said that, I will elaborate. Most of our pet cats prefer UNSCENTED scoopable litter. Unfortunately pet products are sold to humans not to pets. This means the manufacturers cater to our wishes rather than the wishes of our pets. Scented litters have chemical or natural perfumes that are designed to mask the odors of cat feces and urine, but the cat has such a keen sense of smell that they are often overpowering and unpleasant for the cat. I use the analogy of having barrels of moth balls in your bathroom. Most of us have had the unpleasant experience of using the restroom at a gas station or highway rest stop where they just applied the strong scented disinfectants. We couldn't get out of there fast enough!! When you use a scented litter, that is what you are doing to your cat. Any product that is added to the litter is easily detected by your cat. One of our clients complained that her cat was voiding just outside of the litter box. She insisted that nothing about the litter box was new. After further questioning she revealed that she had been adding baking soda to the regular litter. That was enough for her cat to reject the box. An easy fix for that situation: just stop adding the baking soda.

Unfortunately there is no substitute for frequent scooping and cleaning. You should scoop 1-2 times per day, and empty and wash the box once a week. Use only soap and water.

Newer litters that contain carbon may be OK, but it is too soon to tell. The new litters with "crystals" are not time-tested. Some cats may like them, but typically cats prefer natural substances. Some cats unfortunately prefer carpet to cat litter. For these special cases you can get new carpet scraps from a carpet store and cut them into litter box sized squares and place them in the box. Throw them away every few days. After a month or two you can start adding a natural substrate litter to 1/4 of the box. Increase the area of carpet covered by litter gradually over 1-3 months until the cat is back to using litter.

To test your cat's "substrate preference" you confine the cat to a small room with a tile or vinyl floor. Place 5 litter boxes in the room with 5 different types of litter. Include boxes with sand, scoopable unscented litter, peat moss, sawdust, mulch, plain clay litter, carpet, etc. After a few days (or weeks for some cats) you should notice that the cat uses one box more than the others. The cat has chosen, and you must comply.

Some cats do well with automatic scooping litter box devices. These boxes have rakes that are activated a few minutes after your cat has left the box. The rake comes across the litter and drops the scoops into a collection area ensuring that the box is always clean.

I have heard some claims of the dust from fine particulate scoopable litters causing asthma in cats, but i don't know of any controlled scientific studies to support that claim. These claims are usually associated with the use of hooded litter boxes, but some cats prefer a hooded box with scoopable litter. Give your cat what it wants.

The following guidelines should help you to manage your cat's litter box issues:

If your cat stops using the litter box there is a good chance that the cat has a medical problem. You should contact us immediately so we can be sure that the issue is behavioral and not medical. Urinary tract infections are common in cats, and digestive system disorders or painful defecation may cause your cat to avoid the litter box. On rare occasions cats can benefit from stress relieving medications especially in multi-cat households. DO NOT DELAY IN SEEKING HELP. THE LONGER THE BEHAVIOR IS ALLOWED TO PERSIST, THE HARDER IT IS TO CHANGE IT!

As always if you have any questions or concerns call our office at 703-455-6222. Keep those great questions coming!

Puppy's Rough Play

The following question was posed on the AVMA’s website by a veterinarian.  The question is from the receptionist at the clinic regarding her new puppy and its tendency to bite:

The puppy has started playing really rough and I can't seem to control her when she does.  She's starts pulling at a shirt, sock or my arm and foot and won't let go.  When she finally does I will place an appropriate item in her mouth and praise her but she will turn around drop the toy and go for me again.  When she's pulling on my clothing she play growls like if we are playing tug of war (She's just pulling, I don't pull back like in tug of war.  I just try to pry her mouth open to get her off of me and say no).  Sometimes even when I carry her out to the grass she grabs onto my arm, bites hard and won't let go.   I am all scratched from pulling my arm and hand out of her mouth.  I know that you are not suppose to use their crate as punishment but I just couldn't get her under control at one point today (she was biting so hard and scratching with her teeth that I was bleeding).  I went to place her in the kennel which was right beside us and she just kept it up, she headed right out the kennel door and was growling the same kind of play tug of war growl with the toy I stuck in her mouth.  Once I got her in and I let her out a minute later she had calmed down, went to lie down and fell a sleep.   I know puppies bite but I am very concerned about the growling and want to nip (pardon the pun) any problem immediately before it becomes a behavior issue.  I have read the biting puppies handout and will try just walking away next time but it doesn't say anything about growling and that worries me the most.

This is the answer that was given by Dr. Ciribassi, a specialist in animal behavior:

First and foremost, do not over react to this. It is NOT dominance and the dog does NOT need someone to show it who's boss. Puppies use their mouths for play, exploration and teething. It is not appropriate for biting to occur but it is not abnormal. Left untreated, puppies will not develop appropriate bite inhibition and inappropriate mouth behavior can continue. Punishment escalates the problem to force the puppy to use preemptive bites.

When dealing with play aggression you need to look at it from 2 perspectives: prevention and how to deal with the biting as it is happening. For the latter situation, realize the puppy is looking for attention so the best approach is to immediately remove yourself from the interaction. At first this should be by folding your arms and turning away. If the puppy's response is mild, it is best to wait it out and remain in one spot. Be aware that he will get frustrated and crank up the degree of aggression to try to get his point across. You MUST wait this out and not give in by looking at, yelling or pushing the puppy away. If the aggression is too physical to deal with, then walk out of the room and leave it behind (put up a gate or close a door between. Wait until the puppy is COMPLETELY calm for a while before returning. If it is still calm after returning (or if he just relaxes if you have not had to leave the room), go through 10 minutes or so of simple obedience exercises using treat rewards. You are telling him that calm relaxed behavior gets rewarded. If he still gets cranked up, then there is no problem with using the cage for a time out. You do not need to get angry, just be matter of fact. You might want to consider using a head collar and leaving it on with a drag leash to facilitate training and relocating to the crate. Take it off if unattended.

For prevention, you need to go through several short bouts of obedience training each day so that he understands that when he is relaxed, good things happen. Consider using a stuffed Kong during problem times of the day (times when he is more prone to get worked up. Give him the toy BEFORE he gets worked up as a preventative maneuver. Be sure to have scheduled bouts of interactive play OUTDOORS so that he does not associate inside with rough play. DO NOT PLAY ROUGHLY WITH HIM. He does not need to get stimulated. He already knows how to do that. Do not play on the floor with him; do not use hands and feet as play toys. Any time he uses his mouth on you, you walk away. It will not go away overnight but will improve over a couple weeks if consistent.

Toxoplasmosis

We are planning on having children and were told that cats can carry a parasite that could be harmful to the fetus.  Do we have to get rid of our cat?

No you do not have to get rid of your cat!!  What you are concerned about is a protozoon called Toxoplasma gondi.  While this organism can infect many different animals, it only goes through its complete life cycle in cats.  Humans become infected with the organism by eating under cooked meat, or from cat feces.  The infection only rarely results in illness in people.  It is estimated that between 50% and 80% of adults in the United States have acquired the infection, but disease is only seen in patients with immune deficiencies.  The biggest risk of Toxoplasmosis infection occurs when the infection is acquired during pregnancy.  There is significant risk of birth defects during the first trimester of pregnancy.  There is much less risk to the fetus if the infection occurs in the second trimester, and virtually no risk during the last trimester.

Some couples want to have their cat tested for the disease, but this is usually of no value, because cats only shed the organism during the first 3 weeks of their infection.  Cats become infected through eating rodents.  This is yet another reason for keeping your cat indoors.  When a cat eats an infected rodent they will pass spores of the Toxoplasma in their feces.  The organism is not contagious until 24 hours after the cat has defecated.  Once it undergoes sporulation, it can now infect people or other animals.  Since farm cats occasionally defecate in animal feed, livestock become infected when they eat the contaminated grain.  Once the organism infects the cow, sheep, pig, or goat, humans can then eat the infected meat.  Cooking the meat well done kills the organism.  People can become infected via cat feces if the neighborhood cat is using their garden for a litter box.  Wearing gloves while gardening, as well as thorough washing of hands and vegetables will prevent human exposure.

Physicians will often test women for Toxoplasmosis when women become pregnant.  You are actually better off if you are positive on the test, because it means you have been exposed and are immune from acquiring the infection.  If you are negative, you and your baby are vulnerable.  It is best to get tested before you become pregnant if at all possible.  Once you decide to have children, you should take the following precautions:

As always, you should consult with your physician for specific advice for your particular situation.  For more information visit this topic on the CDC website: