My cat’s nose has been white/pale for a while, usually her nose is pink and her mouth too. She is not as active as she used to be. She is only 8 years old — I know 8 isn’t young, but it isn’t old either. Can you tell me what’s going on with my cat?

~Agnes

Siouxsie: We can’t tell you for sure what’s going on with your cat, but it sounds like she may be anemic.

Thomas: Anemia means that your cat doesn’t have enough red blood cells to carry all the oxygen she needs to fuel her body. Symptoms of anemia include pale mucous membranes and lethargy, and it sounds like your cat is showing both of these signs.

Dahlia: Look in your cat’s mouth. Are her gums and tongue pale? Healthy gums are pink in color; if they’re pale pink or white, your cat is anemic.

Siouxsie: Another way to detect anemia is to gently move her eyelid away from its normal position and expose the skin underneath. The “third eyelid,” which will pop out from the inside corner of her eye when you pull at her eyelid, is naturally white, but the skin on the inside of the eyelid is normally pink. If your cat is anemic, it will be pale or even white.

Thomas: Even if after you do these checks you’re still not sure, call your vet and schedule an appointment anyway. Anemia isn’t an illness in itself; it’s a symptom that something else is going wrong in your cat’s body.

Dahlia: Conditions ranging from parasites such as hookworms to chronic illnesses like feline immunodeficiency virus (FIV), feline leukemia virus (FeLV) or kidney failure can cause anemia, so it’s very important that you take your cat to the vet.

Siouxsie: Your vet will draw blood and do a test called a CBC. This will tell him or her whether your cat is producing enough red blood cells and if the cells being produced are normal.

Thomas: Your vet may do other tests like a FIV/FeLV screen, urine analysis, and a blood chemistry panel. The urine test and blood chemistry test will show whether your cat has kidney disease, liver disease, thyroid problems, or diabetes.

Dahlia: Depending on the results of these tests, your vet will recommend a course of treatment that should get your cat feeling better and allow her to spend many more years with you.

Siouxsie: To learn more about anemia in cats, read CatHealth.com’s article on the subject.

Dear Most Esteemed and Knowledgeable Kitties:

My 17-year-old female cat has a growing, bleeding sore under her chin. The vet tried to squeeze it, and the groomer swears it’s a wart. I’m trying to figure out how to stop it from bleeding. She scratches it with her paw when she grooms herself, but otherwise it doesn’t appear to bother her at all. Any suggestions?

~ Jenn

Siouxsie: Jenn, we suggest that you find another vet. Growing, bleeding sores in elderly cats should be a warning sign that further testing, not attempted zit squeezing, is needed.

Thomas: Although your cat’s condition could be nothing more than feline acne, it could be something more serious.

Dahlia: Warts are extremely rare in cats, so we doubt that your groomer’s assessment is correct.

Siouxsie: Dental abscesses can break through the skin and cause sores. But so can cancer.

Thomas: As with humans, one of the warning signs of skin cancer is a sore that won’t heal. And as cats get older, their risk of cancer increases.

Dahlia: Even if your cat does have cancer, if it’s only in the skin it should be fairly easy to remove and allow your cat to live out her natural lifespan.

Siouxsie: And if it’s feline acne, a good vet should be able to offer you easy treatment options that will clear it up for good.

I would like a little kitty perspective on a situation. My sweet pudders, Sasha, is 15 and a very loving kitty. She recently moved with me to New York City when I got married and now lives part time in an apartment in Manhattan. I have to work in Miami two weeks a month and in NYC two weeks a month. When I am in NYC I work from home so she gets to see me and play with me whenever she wants. When I am in Miami my husband plays with her when he can and gives her lots of petting and love, but he often has to work very long days and travels a few days a week, so she is alone a lot for two weeks a month. We take her to our house in the country (2 acres of land filled with birdies and moths and chipmunks to chase and a big house to run around in) every 2-3 weeks for a couple of days, and she gets to go to Miami with me every 6 months or so and gets to play in her house and yard there. But I really worry about the time she is alone in the apartment in NYC – I am afraid she is bored and will get depressed being alone so much. Can you kitties recommend something my husband and I can do to make her time alone a little more interesting for her? … She has recently been diagnosed with renal insufficiency so we want to keep her as active as possible. Any advice you kitties can offer on how we can keep her entertained and engaged while she is alone would be wonderful and greatly appreciated!

~Kathryn

Siouxsie: We strongly recommend that you hire a pet sitter to take care of Sasha while your husband is away. Particularly now that she’s been diagnosed with kidney disease, it’s crucial that she’s not left alone for long periods of time.

Thomas: A good pet sitter will visit with your cat a couple of times a day and spend a good hour with her, playing with her and giving her affection. The pet sitter will also feed her, give her fresh water, check on her health, and clean her litter box.

Dahlia: Pet sitters also keep track of your cat’s health and can generally administer any medications Sasha needs. This is particularly important if she gets to the point in her kidney disease where she needs to have subcutaneous fluids administered.

Siouxsie: In a place like New York, there are lots of pet sitters and pet sitting services to choose from. We suggest that you get recommendations for a sitter from your veterinarian or from friends who have used a sitter’s services before.

Thomas: Pet sitters offer a variety of services that can range widely in price. Many pet sitters are trained in animal first aid — the Red Cross actually offers an animal first-aid course, and you may find it helpful to take that course yourself — and are bonded and insured.

Dahlia: If you have a sitter visit Sasha a couple of times a day while your husband is away, we’re sure your peace of mind will be well worth the money you’ll pay.

Siouxsie: A trusted friend or neighbor could be a good caretaker if Sasha were fully healthy. But because of her illness, you really should hire someone who specializes in working with cats, is able to get her to the vet if she has a health crisis, and can handle giving medications or other specialized services.

Thomas: We have a great neighbor who has taken care of us a couple of times when Mama’s gone away. But Mama says that if one of us was sick, she’d be sure to hire a pet sitter instead of putting the burden of responsibility for a sick cat’s care on her neighbor.

Dahlia: Last year we interviewed a cat sitter, who talked about what cat sitters do, how to find a good cat sitter, and how to help your sitter take the best possible care of your cat. We think this column would help you.

Siouxsie: You could board Sasha at a cattery or at your vet’s office, but we think boarding could be quite stressful for her. Boarding also tends to be quite a bit more expensive than hiring a cat sitter. On the other hand, people who work at boarding facilities and your vet’s office are trained to detect illness and how to give medications or fluids.

Thomas: As long as Sasha doesn’t get any sicker, we think she’ll be all right if your husband works long days as long as he’s home every night. But don’t leave her alone overnight.

Dahlia: We hope this helps, and we hope you find a wonderful cat sitter to play with and take care of your wonderful, special cat.

My cat is 18 years old. I recently found out that she has kidney disease. She was in the hospital for 3 days a month ago. The vet gave me an antibiotic and a supplement; she finished the course of treatment and now she’s eating quite well.  I’m feeding her a blend of the prescription diet wet food and beef broth and cooked chicken liver, and she loves it. Can you suggest what would be the best food to give her?

~Blessu

Siouxsie: According to veterinarians, many cats develop some level of kidney disease as they get older. Cats won’t show clinical signs of chronic renal failure (CRF) until they’ve only got about 20 percent of their kidney function left.

Thomas: It sounds like you’re doing exactly what vets recommend for cats with CRF: You’re feeding her canned food and adding broth to make sure she gets as much fluid as possible. This is crucial for cats with kidney disease, because they need that extra liquid to help rid the body of waste.

Dahlia: The prescription food you’re feeding your cat contains less protein than regular cat foods. Protein causes buildup of phosphorous and nitrogen, and these chemicals need to be excreted by the kidneys. Feeding less protein, therefore, puts less strain on the kidneys.

Siouxsie: But cats need protein to live, so make sure that even if your cat is getting less protein, the protein she’s getting is as high in quality and as usable as possible. That means it should come from meats, not meat by-products, meat digest, meat meal, or grains. Even healthy cats can’t fully utilize proteins from highly processed meat by-products and grains.

Thomas: Unfortunately, a lot of cat foods — including the special prescription formulas sold by vets — contain more by-products and digests than actual meat. They also tend to contain a lot of chemical additives and preservatives, which can tax the kidneys. This list of canned foods and the percentages of protein, fat, phosphorous, calcium, sodium was compiled by a member of an online CRF support group and may help you and your vet determine which foods will work best for your cat.

Dahlia: Because of the chemicals and low-quality meats in many canned foods, some people with CRF cats turn to homemade diets. If you choose to go this route, you need to work closely with your vet and be very careful to ensure that your cat gets all the nutrition she needs.

Siouxsie: Dr. Richard Pitcairn, DVM, co-author of Natural Health for Dogs & Cats, recommends this home-cooked diet for cats with kidney disease: Mix 3/4 pound ground turkey or chicken, 4 cups cooked rice, 4 eggs, 2 tablespoons cold-pressed safflower, soy or corn oil, 3 teaspoons animal essentials calcium, 1/4 teaspoon iodized salt, 1 teaspoon parsley, 5,000 IU vitamin A, 2,000 milligrams vitamin C, 250 milligrams taurine and 10 milligrams of 500-milligram level B-complex. Serve raw or cook 20 minutes in oven and mix in vitamins once cooled. Occasionally, substitute 1 to 3 teaspoons of liver for part of the meat.

Thomas: In addition to providing the proper diet and nutrition, make sure your cat always has a good supply of fresh water. If you have hard water (water that is alkaline due to the presence of mineral salts) or you get your water from a municipal water supply, be sure to use a pitcher with a filter so that your cat doesn’t have to tax her kidneys by processing extra minerals or chemical additives.

Dahlia: Chronic renal failure is a progressive disease, but by feeding the right diet and making sure your cat gets the proper medical attention, you may be able to spend many more happy months (or maybe even years) together. At age 18, your cat is already quite ancient by cat standards; an 18-year-old cat is the equivalent of an 83-year-old person.

Siouxsie: There’s a great online resource for people whose cats have kidney disease. The Feline-CRF-Support group at Yahoo was launched in 1997, and ever since then it has been a resource for information and support for people whose cats have chronic kidney disease. We recommend that you join this group; they’ll probably have some excellent diet recommendations that they themselves have used.

Thomas: Good luck, Blessu, and enjoy your time with your wonderful cat.

I am disabled and a Vietnam veteran and my cat, my best and only friend, has FIV and stomatitis. One vet says he can be helped and one vet says to put him to sleep. Can anyone help me keep my friend with me?

~J

Siouxsie: First of all, J, we want to say we know how hard it is to face losing your friend to this chronic and progressive disease. Mama’s first cat companion had FIV, so she has tremendous compassion for what you’re experiencing.

Thomas: Because of the stomatitis diagnosis, it sounds like your cat is in the third stage of FIV infection.

Dahlia: FIV infection has three stages. The first stage happens shortly after the cat is infected. Sometimes this stage has no symptoms, but some cats develop a fever and other signs of acute illness.

Siouxsie: In the second stage of the disease, the cat has no symptoms at all. This stage can last for many years.

Thomas: In the third stage, an FIV-positive cat’s immune system weakens considerably and he becomes highly susceptible to opportunistic bacterial, viral, or fungal infections.  These infections may improve with a round of antibiotics but then resurface when the antibiotics are discontinued.

Dahlia: Stomatitis, infection and  inflammation of the mucous membranes in the mouth, is a very common condition in third-stage FIV-positive cats.

Siouxsie: Although it is possible to manage FIV, there is, as yet, no cure for the illness.

Thomas: The American Association of Feline Practitioners’ (AAFP) 2008 guidelines for management of retrovirus infections (FIV and Feline Leukemia) publication lays out a few options. It’s written in “doctor-ese,” of course, but here are a few things we pulled out and translated into English.

Dahlia: Some drugs that have been used to treat AIDS in humans have improved immune system function in FIV-positive cats. AZT is one of these, but it tends to have some serious toxic side effects in cats. Alpha-interferon (natural human interferon alpha) has improved survival rates in FIV-positive cats, too, because it stimulates the production of certain types of immune system cells and doesn’t seem to cause as many harmful side effects as AZT.

Siouxsie: Most treatment for FIV-positive cats revolves around managing the opportunistic infections that arise as a result of the cat’s compromised immune system — antibiotic and antifungal medications, for example.

Thomas: The AAFP guidelines recommend avoiding steroid treatment because these drugs can further weaken the immune system. For cats with stomatitis, for example, they recommend removal of all the teeth rather than continuous use of steroids to reduce the swelling.

Dahlia: Griseofulvin, a systematic antifungal drug, is also not recommended for use in FIV-positive cats because it destroys neutrophils. Neutrophils are a type of white blood cell, and since white blood cells are the primary line of defense in the immune system, you don’t want to mess with those.

Siouxsie: Another thing you’ll need to watch very carefully, J, is your cat’s appetite. Cats in third-stage FIV often start to lose their appetites or have gastrointestinal symptoms like diarrhea, and your cat needs his food and fluids to stay as healthy as possible.

Thomas: Some people have added Omega-3 and Omega-6 fatty acids and vitamin supplements to their FIV-positive cats’ diets. There has been little scientific research on the effectiveness of vitamin and fatty acid supplements, but anecdotal evidence suggests that using such supplements with your vet’s guidance is not going to do any harm.

Dahlia: We’re very sad to tell you this, but we think it’s important for you to know. Most of the materials we’ve read (and Mama’s experience with her own FIV-positive cat)  indicate that most cats in the third stage of FIV don’t live much longer than a year, even with treatment.

Siouxsie: So, J, there are treatments that can help your cat to live longer. They may be quite costly, so you need to be prepared for that. But there’s no reason why even third-stage FIV needs to be an immediate death sentence.

Thomas: All this does, of course, depend on your cat’s current state of health and the strength of his immune system. We recommend you go with the “it’s possible to manage this illness” attitude, but be prepared for the financial and emotional cost.

Dahlia: You’ll still need to be vigilant and observe your cat with a loving — if breaking — heart and allow him the mercy of letting him go when he’s ready. As long as you’re able to be honest with yourself about whether or not your cat has a decent quality of life and observe with your heart, you’ll know when he’s tired of fighting.

Siouxsie: In the meantime, enjoy each day with your cat friend, and be present with him. Although your friend’s passing is inevitable, and it would be even if he didn’t have FIV, please try not to worry about when that day will come.

Thomas: Some people try to cope with an impending loss by shutting down their hearts. Try not to emotionally distance yourself from your cat because he needs your love now more than ever. Allow yourself to relish his company and give yourself the opportunity to come to terms with the loss.

Dahlia: There are online support groups for caretakers of FIV-positive cats. One forum we found was the Yahoo Group FIVCats. Joining such a group may help you feel less alone in your quest to give your cat the best possible quality of life. These groups often have forums and lists of resources for coping with grief and loss, too.

Siouxsie: We wish you and your cat the best of luck, J.