That bunny ain't dropping Easter eggs

Years ago, pregnant with my first child and having no veterinary training yet, I acquired a young Nubian goat kid with diarrhea. Fecal testing revealed a protozoan parasite referred to generically as coccidia. A cautious expectant mother, I asked my physician if exposure to goat coccidia was harmful to my unborn baby. When he reported back that goat coccidia (Eimeria spp.) are "host specific" -- meaning goat Eimeria are contagious only to other goats -- I was very relieved.


Flash forward a decade and I find myself, now an animal doctor, doling out this same information to dog owners on a regular basis. Finding microscopic coccidia eggs on an annual fecal float test is not uncommon. Dogs may pass Isospora or Eimeria eggs in their stool, but as with goats these coccidia parasites are "host specific." As I explain this to horrified pet owners, they are relieved to hear it is not contagious to them or their children.

A small sampling of the oodles of eggs
-- coccidia, not Easter -- being passed by two
sick bunnies I saw this month. 

Identifying the presence of coccidia is easy. Now here's where it gets tricky. Remember that coccidia are "host specific." If a dog tests positive for an Isospora-type coccidia it may require treatment because Isospora is a dog coccidia. But if an Eimeria-type coccidia is seen, the dog is simply pooping out the coccidia that a rabbit once pooped out. Quickly differentiating between Isospora from Eimeria based on subtle differences in size or ornamentation takes practice and experience. Nevertheless, seeing as nibbling rabbit poop is a pretty common canine past time, chances are pretty good that many dogs are pooping out a non-canine coccidia.*

Many animals host coccidia without any outward signs of illness. In fact, sickness generally occurs only in very young animals during times of stress. As in my goat kid, coccidiosis may cause severe diarrhea. My yellow Labrador developed screaming diarrhea a few days after we brought him home as a puppy thanks not only to Isospora spp. but also to the stress of leaving his litter. Some of my canine patients--puppy or adult--that test positive for coccidia have unexplained scooting or butt licking without abnormal stools. A short course of treatment for coccidia often relieves all these symptoms.

I recently examined two very young bunnies with diarrhea and lack of appetite. These baby bunnies had been turning up their twitching little noses at hay and pellets for several days, eating nothing but carrots (a treat, not a balanced meal). The day I examined them they had been passing liquid orange stool for several hours. Not having had an occasion to test a pet rabbit's stool before, I was unsure of what I would find. Imagine my surprise when I focused my microscope on the fecal float slide to find hundreds of oval eggs. Coccidia! Eimeria-type no doubt. Treatment with anti-coccidia medication--a teeny tiny portion of the average dog dose--was started immediately, and the owner decided to provide additional nursing care at home.

What fascinates me about this case is not so much identifying rabbit coccidia -- as I explained, we veterinarians see it all the time as an incidental finding on canine fecal floats. It's just that I had never seen so much of it in one place. And never had I paused to think about what the rabbit coccidia might do to the rabbit! The story of these two very sick baby bunnies overwhelmed by coccidia has given this parasite a face and personal meaning to me.


* Cats can be infected with or shed coccidia in their stool as well including various species of Isospora or Eimeria which are not contagious to people. 

Litter Box Laments

One of the most common problems people experience with their feline companions relates to use of the litter box. Or more specifically, non-use of the litter box! Many people automatically assume that urination or defecation outside the designated litter box indicates a spiteful behavior change in their cat. On the contrary, many toileting problems in cats stem from medical conditions. In fact, the only way to prove litter box avoidance is a behavioral problem is to rule out systemic disease.

Posture of a cat straining to urinate,
a medical condition requiring
urgent attention.

Today's blog is not about litter box avoidance due to urinary tract infections, bladder inflammation caused by crystals or stones, irritable bowel syndrome, or systemic disease (such as kidney failure or diabetes). These often treatable conditions are diagnosed by urine, stool or blood tests and imaging studies (e.g., "x-rays," ultrasound) and should always be considered if a previously well-trained feline starts "having accidents" around the house.

So what if your cat truly has a behavioral condition that causes him to abandon the litter box? Cats are fastidious creatures. If something about their litter box is not to their liking they may simply stop using it. My clients often protest that they "haven't changed a thing about the litter box yet suddenly their adult cat won't use it!" A veterinarian professor of mine put it like this: a toddler in toilet-training has no qualms about dropping her pants on the side of the road to use her potty chair when the urge hits, but a teenager wouldn't dream of it! Likewise many cats will tolerate less than ideal litter box setups for years before one day demonstrating that "enough is enough" by peeing or pooping in a preferred location.

Unfortunately what seems like a great litter box set up to the pet owner may be repugnant to the kitty. Consider the following:

Hiding a litter box in a planter seems like a good idea to a
person but breaks Cat Rule Number 1.

1. Your Personal "Porta-Potty." Would you really accept a "Porta-Potty" as a replacement for your home's spacious bathroom complete with ventilation fan? A covered litter box is the equivalent of a public portable toilet. Your meager human sense of smell recoils at the ammonia odor trapped inside. Just imagine how your feline's exceptional sniffer responds!

2. Grand Central Station. For some reason whenever I think about overflowing litter boxes I recall Weird Al Yankovic singing about cleaning "all the bathrooms in Grand Central Station with [his] tongue" in his anti-love song "One More Minute". I'll bet some of you have backed out of a filthy public restroom with a full bladder. I've even met people who won't use an otherwise clean but unflushed public toilet! Is it any wonder then that your cat would rather urinate on a rug than in a litter box that has old waste in it? Litter box waste should be scooped at least daily. The entire box may need to be emptied, cleaned and refilled every one to two weeks.

3. A Very Brady Bathroom. Imagine six kids sharing one bathroom. The inherent conflict is the stuff of which classic Hollywood sitcoms are made! Why then do we think six cats should be forced to share one litter box -- even uncovered and kept immaculately clean? The rule of thumb for litter boxes is "one litter box per cat plus one." Therefore, if you have two cats you should have three litter boxes. And if you're doing the math that means a single cat household should have two litter boxes! To reduce potential inter-cat drama these multiple litter boxes should not be lined up in a row like stalls in a high school lavatory. Also, try to place the boxes on different levels of the home. After all, how would you like to trek from your upstairs bedroom to the basement bathroom in the middle of the night?

Admit it. The basement can be a scary place.
Even for cats -- especially if their only bathroom
is right next to a hissing water heater.

4. Location, location, location. Toilets do not belong in the kitchen. Avoid placing your cat's litter box right next to where you feed him or where he sleeps. (A possible exception to this rule is for the cat who is being nursed through a weakening illness or post-surgical recovery.) A popular spot for the litter box is the basement or mechanical room.  All it takes is the sudden whoosh, whir, or clunk of a furnace, washing machine or other appliance to scare the bejeezus out of a cat settling down to business, and there you have it -- a future litter box avoider.

5. More on the Super Sniffer. Pysch's Burton Guster is not the only one with an exceptional sense of smell. Scent-sensitive people abound. I've had clients whose pet's file was flagged with the note "Remove air fresheners from room prior to appointment! Allergic!" The average cat's sense of smell is said to be about 14 times as strong as the average human's. The "extra fresh" odor controlling kitty litter that appeals to you may knock the socks off your cat. Research shows that most cats prefer soft, sandy litter with no added smells. In fact, any change in litter away from what your cat prefers can cause litter box avoidance. You can skip plastic pan liners (most cats hate them) but make sure you keep 1 to 1-1/2 inches of litter in the box (more is not better here).

6. It's a Cat Thing. When we put ourselves in our cat's "shoes" it is easy to see how the cleanliness and location of litter box can positively or negatively affect his willingness to use it. But some litter box problems stem from feline feelings with which it is hard to identify. For example, most of us do not urinate on objects to claim ownership of them. Nor do we tend to urinate in odd places just to get someone's attention. Territorial scent marking, especially by intact male and female cats, can flare up with the introduction of a new pet, with changes within an established feline family's social structure, or even with the visitation of an outdoor stray merely seen, heard or smelled outside the window! Some cats reportedly urinate or defecate outside the box while staring pointedly at their person as if to say, "Hey, there is something wrong here. Get me some help." It's hard not to get mad, but take a second and listen to your cat when this happens. Then call your veterinarian on his behalf.

An entertaining and enlightening resource for additional litter box management tips is The Fastidious Feline: How to Prevent and Treat Litter Box Problems by Patricia B. McConnell, Ph.D.