I Got 99 Problems and a Box Ain’t One

Lion tamer, with raised whip, directs a tiger toward a large litter box. - New Yorker Cartoon  By: Warren Miller

Lion tamer, with raised whip, directs a tiger toward a large litter box. – New Yorker Cartoon
By: Warren Miller

It is always a point of concern when a cat is surrendered with a history of inappropriate elimination in the home. Having a shelter protocol in place to address each animal is beneficial to rule out particular causes. Evaluation of the inappropriate eliminator should always include analysis of the home environment, behavioral causes, and medical causes.

Evaluation of the Home Environment

It is highly recommended that owners surrendering animals with a history of inappropriate elimination fill out a separate surrender form detailing these circumstances in their home. This simple questionnaire can reveal information that may increase your suspicion of either a medical or behavioral cause. Some question to consider include duration of the problem, changes in the home environment, sources of stress, number of pets in the household, etc. Note where the elimination is occurring (vertical surfaces, one other location, the bathroom, everywhere). Other things to consider are the number of boxes available, their location, their substrate, and their cleaning frequency. These questions may help to identify a stress factor that caused the change in behavior or guide you to evaluate another cause.

Medical Evaluation

Cats that have been eliminating outside of the litter box may have a medical reason for doing so (pain, infection, dysfunction, systemic disease, cancer). If an animal is experiencing painful urination, they may associate that pain with being in the litter box. This association may encourage the cat to seek other seemingly more comfortable places to urinate. It has been hypothesized that animals will seek out cool surfaces such as tile or ceramic that may be considered more comfortable or soothing. It is highly beneficial to have these animals evaluated by a veterinarian. When evaluating the inappropriate eliminator, a thorough physical exam should be performed first. Abnormalities may be palpated in the organ in question or pain may be noted that can narrow down potential causes. Urine should be examined for abnormalities as well as a serum chemistry (blood test) to evaluate kidney function, systemic function, and/or infection. Finally, a focused urinary tract ultrasound, if available, should be performed to observe gross abnormalities associated with the organs in question.

Behavioral Evaluation

Behavioral evaluation may be limited in the shelter to observing litter box habits. Have shelter staff monitor where the cat is eliminating consistently. Changes can be attempted in the shelter to see if the cat prefers a different kind of litter or box size.

The Best Offense



Potential adopters should be notified about the history of inappropriate elimination in previous homes/the shelter. Along with this information, supply suggestions as to what cats prefer in terms of the litter box. Most cats prefer non-scented clay litter and uncovered litter boxes. Cats should have a litter box big enough for them to stand and turn around in (approximately 1.5x the size of the cat). Finding an ideal litter box can be difficult for large cats and geriatric animals that may not be able to easily get into or position themselves. In that case, low sided storage bins (such as under the bed plastic storage) can be used as a cheap and well-sized alternative to the litter boxes pet stores supply. Litter boxes should be placed in quiet areas with minimal foot traffic. The ideal number of litter boxes in a home should be the number of cats in the home plus one. The boxes should be cleaned frequently, ideally once per day and washed weekly. Some cats may require even more frequent cleaning. Even if conditions are ideal, some cats may require troubleshooting. Have resources available for owners and adopters that provide strategies for litterbox success.

Keep in mind that we cannot solve every inappropriate eliminator. If all else fails, consider an outdoor home!


Some Resources





Get the facts: Foster vs. nursery

Kitten nurseries are a hot topic in shelter medicine right now. As more and more shelter jump on the bandwagon it is important that we examine the pros and cons of creating your own kitten nursery and determine what is best for your shelter.  Kittens season lasts from mid spring to early fall and many shelters find themselves overrun with kitten at this time. Traditionally, kittens are either euthanized or sent to foster care until they are old enough for surgery and adoption. Kittens are generally not housed in the shelter due to risk of developing illness and due to physical limitations such as sheer volume of kittens and their high requirements for basic care. Foster care has long provided free labor for cleaning, medicating, feeding and socializing kittens. Foster homes should only have one litter of kittens at a time, which means that they function as quarantine units. Sick and healthy litters are thus kept separate, which is important for reducing spread of infectious disease. Foster care also provides a home environment, to get kittens used to things such as vacuums, stairs and children. Some foster parents end up adopting kittens, or find homes for their foster kittens, which helps expedite the flow of kittens through the shelter system.


While foster care has been a staple for kitten rearing in many shelters, it does have drawbacks. Fostering hundreds of kittens means that you need a dedicated base of individuals who are available to take kittens. Some foster parents only take small numbers of kittens per year, or get burnt out due to emotional fatigue. Foster parents also have differing skill levels. Often shelters have a lack of caregivers who are comfortable–and available–to take bottle feeders or extremely sick kittens. Managing hundreds of foster caregivers is also a huge responsibility–foster coordination takes a lot of time and often requires several individuals to arrange check-ups, make calls and provide care to all the kittens in the system. For some shelters this is simply too much work, or their foster system is not yet developed enough to handle the current numbers of kittens coming through the door.

Enter the nursery. A kitten nursery is a physical location–often a room, trailer or building–which is used seasonally to house kittens. Nurseries are run by paid staff and volunteers, who provide 24 hour care to their patients, functioning much like an ICU in a veterinary hospital. Depending on the scope of the nursery, they may house bottle feeders, weaned kittens, and nursing moms in different rooms, or only provide housing for certain categories of kittens. Having 24 hour staff in short shifts means that instead of hundreds of foster care-givers waking up every 4 hours for bottle feeding, one person can feed the whole ward while the rest of the team sleeps. The nursery can be temperature controlled and all supplies are in one location. For obvious reasons, nursery staff need to be highly trained in kitten care in order to prevent milk aspiration, diarrhea and spread of contagious disease. This means that a supervisor needs to train staff and be accessible for any questions volunteers may have. Good hygiene and biosecurity is essential in nurseries in order to prevent outbreaks of diseases like panleukopenia, coccidia or ringworm. Nurseries also allow for great PR, and are a cause which many people may donate towards–perhaps those same people who didn’t donate to support the foster program or your shelter in general. That being said, nurseries can be costly to run due to increased labor time, utilities, and supplies, which are normally supplemented by the foster care-giver.


Overall, kitten nurseries are a hot new service which some shelters are providing. Foster care will remain a stable of kitten rearing in summer months, but for some shelters a nursery may be a more viable option. Knowing the pros and cons of each paradigm is essential for organizations thinking about making the switch. Remember to create protocols, consult with your veterinarian, and to provide training and support for all those involved–no matter what your kitten-saving strategy may be!

Check out the North Shore Animal Rescue League’s nursery, which includes great PR material including a live cam and information about some of the animal in their care.


When I was seven years old my parents let me pick a puppy from the shelter. I practically chose the first puppy I saw and she was my best friend for just short of 16 years. But within a few weeks of her adoption she chewed all of the hair off of a spot on her chest. We brought her to the veterinarian and within a couple minutes of him disappearing to the dreaded “back room” he returned with a small (but enormous by 7 year old standards) bloody bug on a piece of gauze. It was the coolest thing I ever saw and the next day I wanted to be a veterinarian.



The insect

Cuterebra refers to a group of large parasitic flies that undergoes parasitic larval development in rodents or rabbits. As such, adult female flies lay their eggs around the entrances to dens, nests, or along runways used by their host species. However, cats and dogs can become accidental hosts when they brush against the eggs. Eggs in the fur will hatch after being stimulated by the host’s body heat. The insect will then enter into the host either through the mouth, nose, or open wounds. Once inside the host, the larvae will travel to a species specific location in the subcutaneous tissue (space between skin and muscles). The insect will form a breathing hole through the skin, and within 30 days it will mature and exit from the host where it will enter the soil in order to pupate into an adult fly.

Clinical findings

Typical infections manifest as an approximately 1 cm fistulous swelling in the head, neck, or trunk. Cats will aggressively groom the area and it may or may not be painful depending on the presence of secondary infection. Aberrant migrations manifest as abnormal signs in the area of migration which can include the brain, spinal cord, eyes, nasal passages, and or pharynx. Ocular migrations can manifest as chemosis, blepharospasm, uveitis, or blindness. Nasal or pharyngeal migrans can manifest as upper respiratory infection, nasal discharge, or coughing. Neurologic migrans are more often observed in free roaming cats in late summer. Signs can include depression, seizures, lethargy, central blindness and vestibular disease. Neurologic manifestations are often preceded by an episode of violent sneezing weeks to months before signs develop.




To remove the larva, carefully probe and enlarge the breathing hole with a pair of small (e.g. mosquito) hemostats. Covering the bot with lubricant for 10-15 minutes may facilitate bot removal as it encourages the bot to seek air. Do not squeeze the larvae as rupturing it can cause a chronic foreign body reaction or secondary infection. After removal, flush the wound with sterile saline and debride if necessary. The wound should be allowed to heal open, no stitches are required. Antibiotics may be required in severe infections, but after removal of the larvae many animals heal quickly. When the bot cannot be removed, treatment is more challenging. Ivermectin has been used for cats with CNS cuterebriasis, but in some instances progression occurs too quickly.


Cuterebra are fairly common external parasites of domestic animals, especially cats and kittens in summer. Identification and removal of the bot is essential for successful treatment. While most animals present with draining wounds, keep cuterebra in the back of your mind for unusual neurological or ocular cases. Have you seen any interesting cases of cuterebriasis? Post your brags and horror stories below, and we’ll see you next week!

Kitten Cuddling 101 by Allison Cowen

The following is a guest post by Allison Cowen, DVM class of 2016 at Cornell University.

When people ask me what I’m doing this summer I tell them I am playing with kittens, professionally. While this is by no means 100% true, it comes closer than most jobs could. Let me explain.

At some point during my second year in veterinary school I approached Drs Berliner and Scarlett with a proposition: “I want to do research at the shelter. Can you help me?” We sat down for several meetings with some of the Maddie’s(R) shelter medicine crew and the brainstorming began. The goal was to find a project that was do-able in several months, would be interesting, but most importantly would be relevant and helpful to shelters.

charlieIt was the second or third meeting when Dr. Berliner said “Wouldn’t it be nice to know how kittens grow in foster care and in shelters?” The answer was unequivocally “yes”, and so the idea was hatched, and we ran with it. I did a comprehensive literature review to see what information was out there regarding growth rates in shelter kittens and foster kittens. Nada. I looked for papers on disease occurrence and mortality in shelter kittens and foster kittens. Nada. In total, I found several papers that looked at these factors but only within environments that differ greatly from the shelter and foster environments, ie catteries, private homes, pathogen-free colonies, feral colonies, or in adult populations. But these are inherently very different situations.

The orphaned malnourished kitten with snot coming out of its ears, eyes, nose and feet that was found in a drainpipe may grow at a very different rate from the purebred Siamese kitten in the cattery being sung to sleep every night. So it would be nice to know, is the universally accepted “1-pound per month” rule for kitten growth even relevant for kittens under these disadvantaged circumstances? What is normal for a hungry worm-filled kitten, and what is worrisome? Our hope for this study is that we will establish a normal rate of growth for kittens in these two very unique situations (shelter and foster care), and be able to use this information when monitoring the health of future kittens. We are also tracking disease occurrence as well as mortality in hopes of being able to draw correlations between some of these variables.

And so my career as a kitten snuggler began.

In actuality though, there is very little snuggling that goes on, as I do not want to become fomite-number-one. My days typically go like this: wake up, tend to whichever foster kittens I have at my home (including weighing them in what I have affectionately dubbed “the kitten cup”), head off to the shelter. I get out my data recording forms (every kitten gets its own form) and the kitten cup and work my way through the shelter kittens following these important steps:

  2. Check to make sure I’ve got the ID number written down on the form matches the corresponding kitten (nothing worse than invalid data!)
  3. Pick up the kitten from the cage and try really, really hard not to snuggle it (by far the hardest part of my day)
  4. Place the kitten in the kitten cup, and jot down its weight
  5. Check its face for any ocular or nasal discharge
  6. Put kitten back
  7. Repeat all those steps for any kittens in the same cage
  8. Check its cage for stool quality, and also note how much they’ve eaten
  9. Take off gloves, spray down scale, and maybe even change scrub top if the kitten forced you to snuggle

cutieI do this for every kitten in the shelter every day that looks to be less than or around 8 weeks old. For the foster kittens, these responsibilities fall on the foster providers. Fortunately, Tompkins County SPCA has a really awesome and dedicated pool of foster parents, most of whom are more than happy to help with this and have been amazing about tracking each kitten’s weight, fecal quality, eating habits, and any disease and subsequent treatments. Much my day involves corresponding with the foster care providers, making sure things are going okay, and bringing them anything they may need – new forms, a scale, etc.

As someone who previously thought she was not a “research person” I can 100% tell anyone that whether or not you are a “research person” depends on what you are studying and whether or not you care. This has been an absolutely rewarding summer because I care about the project and am genuinely excited to see what our data holds. And of course a large part of what makes this project SO easy to care about is seeing the kittens day after day and knowing that these will be the beneficiaries of your research. I truly hope this information will be helpful in the future – helpful to shelter staff, to foster parents, to veterinarians, and most importantly to the kittens.

And lastly, a huge thank you to Drs Berliner and Scarlett, the Tompkins County SPCA staff, the dedicated foster parents, Maddie’s Fund, Morris Animal Foundation, and American Humane Association for making my summer wonderful.

Revisiting feline infectious peritonitis

imageOn July 18-20th, the annual ASPCA Cornell Maddie’s Shelter Medicine Conference took place in Ithaca, NY. There were many engaging speakers from different aspects of shelter care. One of the speakers was Dr. Elizabeth Berliner, who is the Janet L. Swanson Director of Shelter Medicine at the Maddie’s Shelter Medicine Program at Cornell University. Dr. Berliner gave the last lecture of the conference, and overview and advances in the identification and development of feline infectious peritonitis (FIP).

Corona virus is very common among our small animals. Corona can be transmitted fecal to oral, through the saliva, as well as across the placenta. The virus primarily affects the lining of the GI tract, causing self-limiting diarrhea. However, there is potential for the virus to mutate into a highly pathogenic variant. The mutation allows the virus to enter into macrophages, a type of white blood cell, which will have effects on the host based on the severity of the virus and the host’s immune system. Some cats potentially clear the virus, others experience inflammation of blood vessels which leads to fluid build up in the abdomen or chest.

Clinical signs of FIP can include lethargy, anorexia, icterus/jaundice, and a waxing and waning fever. Abdominal masses may be palpated as a result of granuloma formation. Remember to look at the eyes! Blood in the eyes, color changes, inflammation and retinal changes may be some of the earliest signs observed. Neurologic abnormalities may also be observed, but keep in mind major differentials such as lymphoma, heart failure, liver disease, and bacterial peritonitis/pleuritis.

FIP is a disease of younger cats, generally from 6 months to 2 years. Currently, we believe that there is good evidence that the disease has a genetic component, since multiple kittens from one litter can all develop the disease. The cats with a litter mate that has developed FIP are 2-10 times more likely to develop the disease themselves, likely through a combination of genetics and exposure. Non related kittens have no increased risk of FIP development than any other kitten. Unfortunately there is no treatment or effective vaccine for the disease. Anti-inflammatory suppression of the immune system may serve to make the cat more comfortable, but does not alter the disease progression.

Interestingly enough, ferrets develop a remarkably similar corona virus mutant with many of the same clinical signs and clinical pathology abnormalities observed.

For more information, visit http://www.dr-addie.com

Kitten, puppies and ascarids, oh my!

ascarids_2As kitten season marches on, shelters across the country are pulling out their Strongid and their Nemex and are vigorously deworming kittens. It is common knowledge that all young animals have worms, and that frequent deworming is necessary. But why is that? This week we will be diving into the specifics of the large roundworms of puppies and kittens, also known as ascarids. Ascarids are some of the largest, hardiest and most common worms seen in our domestic animals. Cats and dogs each have their own, unique ascarid known as Toxocara cati and Toxocara canis respectively. They can also both be infected with a less common ascarid called Toxascaris leonina. Ascarids are commonly 10 – 15cm and are easily seen in the feces of infected animals.

Adult ascarids live in the intestinal tract of dogs and cats and their eggs are shed in feces. The eggs themselves have a thick, sticky, tough outer shell which protects them from the environment. This is why the eggs tend to get stuck in fur or carpet, and are hard to destroy. The eggs in the feces take 2 weeks of growing in the environment before they are infectious, which is why prompt cleaning is so important in a shelter. Eggs are eaten by the animal when they eat anything which has been contaminated with feces, groom themselves, etc. Eggs can also be eaten by other animals such as rodents, who are then infective to dogs or cats if consumed.

The eggs hatch in the stomach of the animal, but do not take a direct route to the intestines. The baby worms migrate through the body, passing through the liver and lungs in their way to the small intestine. Occasionally larvae are lost on their way to the gut, and become trapped in other tissues such as kidneys or muscle, where they do not develop and become dormant cysts. In a pregnant dog these cysts  are activated in the last trimester, and the worms migrate across the placenta to infect the puppies. Thus, puppies are born with worms already growing inside. Similarly in cats, the worms migrate to the mammary glands and are shed in the milk to the newborn kittens.5735449110_bd2f3cdb4d_z1

Normally, infection takes a month or two  from the time an adult animal eats the egg until the worms are fully developed. In puppies it can be much sooner, due to the prenatal infection (3 weeks), which is why early deworming of puppies is so important. Relative to a puppy’s intestinal size, even a small number of 10cm worms can cause serious gastrointestinal upset or even death. Kittens, on the other hand, take longer to develop adult worms because they are infected after birth, but should still be dewormed on a similar schedule as puppies.

Only pyrantel pamoate (Strongid, Nemex) is labeled for use in puppies and kittens as early as two weeks of age. Because this drugs is inexpensive and relatively safe, it is usually the go-to for shelters. Puppies and kittens should be dewormed every two (2) weeks until at least 12-16 weeks of age, by which time they are hopefully adopted. Many other products are effective against ascarids, but toxicity and off-label usage is a concern.

Remember, keeping a clean  environment will go a long way to preventing reinfection of young animals! Killing ascarid eggs is very challenging and they can stay viable in the environment for extended periods. Thoroughly clean surfaces to mechanically remove eggs, then use diluted bleach to strip away the protein layer of the eggs, leaving them vulnerable to desiccation. Play yards and outdoor spaces are impossible to clean and heavily contaminated spaces may require a fresh layer of dirt or gravel placed on top. This is just another good reason why play yards are not for puppies!

I hope you’ve enjoyed this information about ascarids in puppies and kittens. Stay tuned until next week for more parasitology fun!

Kitten season is coming!

4637520716_cecb325a07_zBrace yourselves, kittens are coming! In case you didn’t know, kitten season is upon us and shelters across the nation are already receiving their first batches of kittens. If your shelter or rescue hasn’t started prepping for kitten season then now is the time! After the winter solstice (Dec 21) queens will start going into heat and becoming pregnant, kittens may trickle in, but now is the time to begin preparing. Consider the pitfalls or bottlenecks from last year and how will your shelter tackle it differently? Now is also the time to begin stocking up on supplies and making sure leftovers from last year are still good. Some important items include warm kitten bins, tubs or cages, powdered milk formula, bottles with working nipples, gram scales and microwavable heating discs. Create a shelter wish-list and ask for donations from the community. Being very specific in which items, brands and quantities you require will make it easier for people to donate.

This is also the time of year to celebrate the wonderful people who make kitten rearing possible: foster parents! Begin recruiting new foster homes and refresh the memory of your long-time foster parents by throwing a Kitten Shower or orientation seminar. Ensure everyone feels comfortable with their roles—not every foster parent will be equipped to take on a dozen three day old kittens to bottle feed all night. That being said, make sure you know how many foster parents can handle kittens which are sick or require special care. It is important to provide education and resources for your foster parents. If you haven’t already, check out the San Francisco SPCA’s Kitten Foster manual! This gem is a great resource and answers pretty much any question a foster parent may have.

Make sure that your shelter has a system set up for provision of veterinary care, emergencies, and follow up appointments. Managing a large number of foster kittens and their people is a challenging and requires a lot of manpower. Every shelter should have dedicated individuals with specific roles to make this kitten season a success. The Animal Rescue League of Boston has a wonderful Foster on Deck program which helps with the flow of foster homes.

It is a lot of work, but preparing now will pay off in the end. Let us know what resources have worked well for your rescue or shelter group in the comments section below. Best of luck for 2014’s kitten season everyone!