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.

The Wonders of Canned Cat Food

"You are what you eat" the old saying goes. Taken literally we can get a little carried away. After all, I am not a 5'5" chunk of string cheese (much to my husband's disappointment). Of course, we all know it means our bodies will be healthier if we fuel them with health food rather than junk food.

Pet owners have become extremely health conscious on behalf of their cats and dogs. They realize that the food Fluffy and Fido eat day in and day out must be nutritious and wholesome. Sometimes the adage "you get what you pay for" applies to pet foods but sometimes it does not. Consumers will be wise to remember that all pet food companies aim to make a profit through selling their product. Pet food marketing strategically plays upon our emotions as animal lovers. We want to feel we are doing everything possible to provide a safe and satisfying life for our pets.

Rather than take out a second mortgage on your home to buy that premium bag of dry cat food, please take a moment to read about a "revolutionary" approach to feeding felines. An approach that may reverse feline diabetes, reduce the incidence of urinary crystals and kidney disease, decrease food-related vomiting and allergies, and keep your cat lean and playful into old age.

The answer to your cat's prayers (even if he doesn't know it yet) is canned cat food. When I said this was a "revolutionary" approach I was being ironic. Canned cat food more closely mimics the diet felines evolved to eat--mice.

A mouse is a high protein, high moisture, low carbohydrate meal. Dry cat chow is a low protein (or mostly plant-based protein), low moisture, and through-the-roof-high carbohydrate meal. Eating an exclusive diet of dry cat kibble leaves the modern cat morbidly obese and chronically dehydrated. Obesity leads to diabetes, cancer, arthritis, skin problems, and more. Chronic dehydration assaults the kidneys, and triggers bladder diseases ranging from infection to crystals/stones to sterile cystitis. Poor quality or species-inappropriate proteins are claimed to trigger skin allergies and gastrointestinal inflammation ("puking cats"). Quality of life suffers as cats put up with discomfort on these many levels. Is it unlikely that some of this angst shows up as "bad" behavior?

I do not believe dry cat food is evil personified. However, kibble is just not perfect nutrition for the mighty feline hunter. It is a myth that dry cat food helps keep a cat's teeth clean. If you ate nothing but granola, never brushed your teeth and never visited a dentist...I shudder at the thought.

You may argue that canned food gives your cat the runs or makes him puke (this is usually a temporary problem during transition). Or worse that he doesn't like to eat it at all. Unfortunately, switching from highly-addictive carb-rich dry food to high-protein wet food is not always a simple task. Is it always easy to put down the bag of nachos and pick up a stalk of celery instead? Dry cat food is coated in a highly appetizing animal digest that makes kibble as tasty to most kitties as fast food is to most Americans (hmmm, is there a correlation?) It can take months to convince some cats that canned food is...well, the cat's meow. It took eight months and untold patience on his caregiver's part before my diabetic patient Tucker relinquished his dry food in favor of the canned variety. Lo and behold his diabetes improved practically overnight! Dr. Lisa Pierson, DVM's handout "Transitioning Feline Dry Food Addicts to Canned Food" is an amazing how-to manual on teaching cats to love canned diets.


Ounce for ounce canned food is more expensive than dry kibble. For those cat owners who spare no expense, it may be a small thing to re-allocate the money spent on the premium dry food to cans instead. For those of us who operate on a tighter budget, we can certainly compromise. Is it affordable and practical for you to feed one moist meal a day? Even just several canned food meals a week can improve the overall health, activity and attitude of your feline friend.

Some tasty tidbits:
1) Normal cat poop is not voluminous and stinky. Cats that eat quality animal-protein moist foods exclusively pass smaller, firmer, less odorous stools. If you've even seen coyote or raccoon scat in the woods, you'll understand what a predator's waste should look like -- including your cat's.
2) Cats did not evolve eating fish. They evolved eating rodents and birds. While most cats like the taste of fishy cat foods, try not to feed fish varieties exclusively. I haven't seen "mouse" or "sparrow" flavored canned foods in the pet store yet, so you will have to stick to "beef" and "chicken" for now. (Yes, there are frozen raw food diets out there that more closely mimic a cat's wild diet...more on this later.)
3) If your cat gets on board with you and eats nothing but canned food from here on out, make sure it is "complete and balanced". Canned foods labeled "for intermittent or supplemental feeding only" are missing essential vitamins, minerals and amino acids -- fine as a snack, not for a lifetime.
4) Wet food diets do present very real challenges in the mechanics of feeding. We have become so used to shoveling dry food into our cats' bowls that it seems like the natural thing to do. It takes more thought and care to keep moist food fresh and appetizing. One suggestion is to freeze several meals and put out two meals each day--one meal warmed to "mouse body" temperature and the second left frozen to thaw throughout the day.
5) A mouse is approximately 30 calories. Cool factoid, huh? The average wild cat eats 7-10 mice per day, which is the equivalent of 210-300 calories. And they burn a lot of calories actually catching, killing and eating that mouse! (Oh yes, cats that eat wild meals like mice should be dewormed regularly...just because something is all natural does not mean it is completely without negative side effects.) Check to see how many calories are in a single 8 ounce cup of your cat food...

Feline Urethral Obstruction, a Common Cat Emergency

I'm superstitious and I know it. I holler at my staff when they exclaim what a peaceful day it has been in the clinic. Such statements practically guarantee that a complicated life threatening emergency will walk in the door at 4:55 p.m. I find myself "knocking on wood" to secure little blessings and remarkable recoveries. Also, I am convinced bad things (or just plain weird things) happen in threes.

Within a 24 hour period this week, we had three feline emergencies -- urethral blockage.

Male cats have a narrow urethra, the tubular passage from the urinary bladder to the outside world. Because it is so narrow any number of things can plug it up causing an excruciating and life threatening emergency. Bladder stones, "crystals," mucus and blood clots can get stuck anywhere along the urethra preventing the cat from emptying his bladder.

Signs this is happening include spending an inordinate amount of time in the litter box, licking excessively under the tail (specifically the penis), straining so hard to urinate that stool comes out (or vomit), yowling in pain (especially when touched on the belly), walking funny (because the bladder, located between the hind legs, is distended and painful), decreased appetite or thirst, or hiding.

A male cat crying while repeatedly posturing
to urinate yet producing little or no urine
can signal urethral obstruction, a life
threatening veterinary emergency

By the time most owners notice these signs, the cat has already been blocked for several hours. A "wait and see" attitude in a blocked kitty will result in a dead kitty. If the cat is not seen by a veterinarian for treatment the bladder will continue to stretch (sometimes causing permanent damage to the muscles and nerves involved in contraction) and may rupture, kidney function will be compromised, and vital electrolytes will go haywire. In particular, if the potassium gets high enough the cat can have a heart attack and die.

Any time an owner calls worried about a male cat yowling in pain or straining to "poop or pee" I want to see it immediately. Urethral blockage is usually pretty simple to rule out, so I'd rather be safe than sorry if the cat is acting weird for some other reason!

No two "blocked" kitties are the same. However, I generally follow a certain diagnostic and treatment protocol initially:

Yellow arrow points out numerous large bladder stones in
this cat which will require surgical removal

1. Take x-rays of the abdomen to determine if there are bladder stones that need to be surgically removed after dealing with the immediate problem of "unblocking" the cat. 
2. Perform bloodwork to assess kidney function, electrolyte balance, blood counts, and more. 
3. With the cat under sedation a urinary catheter is passed to relieve the pressure in the bladder.
4. A urine sample is obtained to check for infection, crystals, kidney function, etc. Medications and diet changes may be prescribed based on this information.
5. The kitty is hospitalized for one or more days while we flush the bladder, treat infection, rehydrate the patient, rest the kidneys and balance electrolytes. 
6. After the urinary catheter is removed the cat is closely monitored to make sure he does not re-block.

Most cats who have been treated for urethral blockage require special lifelong management at home. This often includes a prescription diet made to dissolve and prevent crystals from forming. Canned food is recommended to increase water consumption and flush the bladder of crystals and cellular debris. Unfortunately some cats with recurring obstructions require special surgery to open up their urethral opening so they "pee like a girl cat" and are less likely block again.

Cats are famously good actors. They hide discomfort and serious illness until the last possible moment. Routine veterinary care including periodic blood and urine tests is very important for keeping cats healthy especially as they age. Subtle changes in your cat's weight, appetite, thirst and litter box habits, socialization and behavior can signal important changes in health. Trust your instincts and get him to the veterinarian!