>>


Dear Reader, All advertisements on this site 
are selected by Google, not Dr. Hines
If you have a cat that is + for feline leukemia
or feline AIDS and it received raltegravir 
(Isentress ®) = a human AIDS  medication, 
feline interferon omega, thiamine, 
niacinamide or slippery elm bark in its treatment
plan; I would very much appreciate 
knowing  the results. RSH email

 

 

 

 

 

 

 

 

 

 

Cat Claws - Part 2

 

Ron Hines DVM PhD

Let me start by telling you that I am not suggesting that you declaw your cat. What I am suggesting is that you not be too judgmental, too myopic or too quick to castigate cat owners who decide to do so. Sometimes, it is the elderly, the frail and the disabled who need a feline companion the most.

I spent much of my career at the NIH working for the Surgeon General. Like the CDC, our mission was to protect your health. That imbued in me a mindset that I needed to look out for your health as well as that of your cat. You probably got here through my article on declawing of cats. If not, you can get there here.

There I told you in that that I estimated that problems associated with cat’s clawing could be solved without surgery in about 80% of house cats.  I told you that my cat, Oreo, is not declawed because I did not find it necessary. I just clip and file his front claws from time to time.

This article is about the other - perhaps 20%. The cats for which that surgery might still be the best solution. I get trolled now and then for the things I write. Generally it is led by the AVMA for giving you advice online; or by militant cat and dog-interest groups who do not agree with me. (ref)  I catch the same flack from them for suggesting that you delay spaying immature pets. (ref)

 

 

By virtue of their large war chests, militant cat and dog interest groups have disproportionate influence over American society. They tend to disseminate and lobby for simplistic, eye-catching solutions to complex, difficult to solve, problems. I’ll always tell you what I believe to be true – but it won’t always be what you or they want to hear. Here are some things about cat claws that those folks are not going to tell you about:

Cat-scratch Disease / Bartonella henselae

Cat-scratch disease (CSD) is caused by a little bacteria (a coccobacillus) named  Bartonella henselae. This bacteria generally makes its home in the cells that line the blood vessels (the endothelium) of your cat’s body; but they appears free in its blood from time to time. Veterinarians a physicians used to believe that when a cat or a human was infected with Bartonella, it caused a disease that was quite mild and only lasted a short time (benign). That opinion is changing. The most common way one becomes infected with Bartonella henselae is through the scratch of a cat.

In many ways, cat scratch disease is similar to Lyme disease.  They both have the ability to produce a tremendous variety of symptoms or no symptoms at all. They both involve the complex interplay between animals, parasites and humans.  They are both quite difficult to diagnose because they produce signs that mimic so many other diseases. Both can produce lingering illnesses that are very hard to treat. In both, the upswing in cases are due to changing human lifestyles, changing demographics and better tests to identify those that are infected. (ref) Neither are easily eliminated with antibiotics. Neither have effective vaccines. And neither Bartonella nor Lyme disease are amenable to simple or simplistic solutions.

When a cat harbors Bartonella anywhere in or on its body; you can assume that at points in its life it will harbor the organism on its claws as well. (ref) It is estimated that more than half of cats residing in areas where fleas are common harbor Bartonella at some point in their lives. (ref)

You can also assume that at some point the owner of a cat will get scratched. Most often, but not always, that scratch was inadvertent. Perhaps the cat was held or petted longer than it wanted to be or held incorrectly. Perhaps the cat was startled. Perhaps you stepped on its tail. Perhaps a young child pursued it. Perhaps it was play pouncing.

Physicians still believe that most people who contract cat scratch disease will recover with no lasting damage. But they are realizing that in a host of health problems that were not previously recognized as being due to Bartonella, the cat scratch organism was the underlying cause. That is most common in the elderly, the young, and folks whose health is tenuous for other reasons. But it can occur in anyone and, from year to year, it is being diagnosed more frequently in humans. (ref1, ref2, ref3)

The Danger To People With Heart Issues :

Heart valve problems and heart murmurs are quite common in humans. Some need no treatment, some can be treated conservatively with medication, and in some, heart valves needs to be replaced. In other cases, the thin lining layers of the heart are inflamed (endocarditis). Cat owners in all those situations are more susceptible to severe complications of cat scratch fever should they be exposed to it. (ref1, ref2, ref3 , ref4, ref5)   Sometimes, the diagnosis can only be made by removing a small biopsy specimen (snippet of tissue) from the patient's heart valve itself. (ref)

I do not believe that people in imperfect health should be denied the companionship of a cat. Nor a cat be denied the companionship of a loving owner. I would have no ethical problem recommending that cats belonging to a client of mine with any of these health concerns be declawed. My recommendation would be the same if it was another member of their family who was similarly affected. But I would want the surgery to only include the claw itself and its subcutaneous generative tissue. The procedure has gotten most of its bad reputation from ham-handed veterinarians who remove far too much tissue and bone. I would also inform them that a cat bite or perhaps even a flea bite could pose a similar danger.

Weakened Immune Systems And The Elderly

When a human being is inadvertently scratched and develops cat scratch fever, it is their immune system that must battle and defeat it. During our mid adult lives, most of us have a robust immune system. But as we age, our ability to fight infections decreases. Other people are born with defects in their immune systems that make them less able to combat infections from birth. Still others of us loose our ability to fight infections like Bartonella due to conditions like lupus, AIDS (ref), cancer or chemotherapy. Still others become more susceptible to Bartonella due to joint replacements.

Anything that lowers a cat-owners CD4+ T cell count is likely to make that person more susceptible to these infections. (ref)  That can be no more than a person having to battling two infections at the same time. (ref)  or having to take medications that lower blood lymphocyte counts such as corticosteroids (ref), radiation therapy, chemotherapy, methotrexate (ref) MS treatments (ref1, ref2), Lupus  treatment (ref1, ref2) etc.  

Cat owners with diabetes can also have less ability to fight scratch and wound infections. That goes for cat scratches and bites that carry Bartonella as well as the other organisms I mention farther down the page. (ref1, ref2)

With the aging of America and the western world, the dangers of cat scratch fever to the old and infirm is likely to increase.

I do not believe that people in imperfect health should be denied the companionship of a cat. Nor a cat be denied the companionship of a loving owner. I would have no ethical problem recommending that cats belonging to a client of mine with any of these health concerns be declawed. My recommendation would be the same if it was another member of their family who was similarly affected. But I would want the surgery to only include the claw itself and its subcutaneous generative tissue. The procedure has gotten most of its bad reputation from ham-handed veterinarians who remove far too much tissue and bone. I would also inform them that a cat bite or perhaps even a flea bite could pose a similar danger.

Bartonella As A Threat To Your Veterinarian

Who is most likely to be scratched by a cat? Of course, it is your veterinarian and his or her employees. So it should come as no surprise that veterinarians and folks that work with lots of cats lead the list when it comes to Bartonella henselae exposure. (ref1, ref2, ref3) Veterinary medicine is a high stress profession. (ref) So a lot of the symptoms seen in these studies could have had causes unrelated or only partially related to their exposure to cat scratch fever. Another major failing of our professional association, the AVMA, is that this has not been adequately explored.

What Are Some Of The Possible Symptoms If I Were To Catch Cat Scratch Fever ?

A few days to about two weeks after the scratch or bite of an infected cat, the wound area often appears reddened - perhaps something like this. Its not unusual for a cat scratch to look like that for a day or two after the incident – but not  for it to persist or for warmth or pain to persist at the spot. It is common for people who have contracted Bartonella to then experience headache, chills and fever. A tell tale sign that sometimes occurs soon after is tenderness and, perhaps, swelling of the lymph node closest to the scratch or bite. It it was on the arm, then the axillary lymph nodes. Perhaps similar to a stylized diagram you can see here. If the scratch or bite was on the leg, it would probably be the lymph nodes of the groin. However, some people experience none of those symptoms when infected with Bartonella. One frustrating characteristic of Bartonella is that its initial symptoms, if any, are so unpredictable. The majority of people - those with a robust immune system and no compounding health problems - recover without treatment. However, some will go on to have more serious, long lasting side effects. Many cases are initially misdiagnosed and tests to confirm Bartonella infection are not particularly sensitive. (ref)

I mentions heart complications earlier. Here are some others that have occurred:

Scratches To The Eye

It is not uncommon for an annoyed cat to take a swat at a cat owner, family member or house guest's face and eye. Some folks read a cat's mood accurately. But others are oblivious to the warning signals cats gives when disturbed. When the Bartonella organism enters by that rout, the results can be extremely serious. (ref1, ref2, ref3

Paralysis

Occasional serious complications of cat scratch fever involve the nervous system. How they progress is highly dependent on the vigor of the person's immune system. Most get better with time. (ref1, ref2, ref3, ref4)

Are There Other Diseases That Cats Can Carry On Their Claws ?

Yes. There are many

Rickettsia felis is the latest candidate. But as to scratch transmission, we really do not know one way or the other yet. Like Bartonella, R. felis also catches a ride on cat fleas and when it infects people, the fever, rash and headache it produces are quite similar to cat scratch fever. Occasion it affects on people are considerably more severe. (ref)  One author mentions that it can be passed through wounds. But he does not mention a scratch. (ref)   In some areas of the world, the organism has become even more common than Bartonella. R. felis wasn’t even recognized as a threat to humans until 1991. When people catch it, it is called flea-borne spotted fever. (ref)  Earlier cases in people were probably misdiagnosed as typhus. (ref)

Again, it is your veterinarian who is at the heads of the list for exposure risk. (ref) In my experience, veterinarians are considerably more likely to be scratched by a cat than bitten by a cat flea. Diagnostic tests (including PCR) for exposure to this organism are not particularly sensitive. (ref) Although there is more awareness among the medical community of this pathogen than there once was, we still know quite little about the many ways it moves about. Historically, these organisms caught a ride on fleas and ticks. But with the increase in the pet population density, other transmission opportunities might exist (ref) R. felis transfer through a scratch has been proposed. (ref)

But other infectious organisms can definitely infected humans through the scratch of a cat. Pseudomonas bacteria for one. (ref)   Pasteurella and strep bacteria as well. (ref1, ref2, ref3)  Another organism that has been known to transmit through cat bites is Capnocytophaga canimorsus.  When transmitted to people in poor health, the mortality rate has been stated to be 30%. (ref1 , ref2, ref3)  In one study, 57% of cats were found to carry this organism (ref);  in another 17%. (ref)  

Antibiotic Resistant Bacteria

When cats must receive frequent or periodic antibiotics, they can develop strains of  antibiotic-resistant bacteria that can be hard to treat when they jump to their cat's owners. (ref) Certain breeds, Such as Sphinx and Devon Rex are quite prone to skin infections that require antibiotics. Among these ominous antibiotic-resistant bacteria, are the MRSA staph.   (ref1, ref2)

All can be passed to humans through a cat's claw scratch. When they do, it is the elderly or those with imperfect immune systems who suffer the most fatalities. (ref)   Lets say, just for example, that you are a member of a group that takes your house cats to nursing homes and long-term care facilities to keep the resident's spirits up. People confined to those facilities long for interaction with pets and people. Volunteering to visit with your pet is a very compassionate thing for you to do. Might it also be compassionate if those therapy cats were declawed? (ref1, ref2) What if it were your mother, your father or your dearest friend who was scratched when they came to visit your home?

Enough About People - Are There Cats  Whose Health Might Be Better Off If They Were Declawed ?

Yes. Those cats exit too:

Cats With Severe Itchy Allergies

It is not that uncommon for cats to have very itchy allergies. (ref1, ref2 )Those cat can literally tear their skin to pieces scratching. Sometimes its just a flea allergy that can be corrected. Sometimes allergies that severe can be controlled with special diets, etc. Antihistamines do not provide much help for these cats. But sometimes bringing them relief require high doses of corticosteroids or powerful medications that can produce severe side effects themselves. (ref) Are long term corticosteroids, tranquilizers, cytotoxic drug and Elizabethan collars more humane than declawing these cats? Iatrogenic means caused by the treatment itself - in this case, corticosteroids = (ref)

Eosinophilic Granulomas Complex

You can read about this baffling disease here. Veterinarians are still unsure why some cats develop it or what triggers the intense scratching and self-trauma that some forms of this disease produce. (ref) Flea control must be scrupulous. Claws can be blunted and smoothed weekly; claws can be capped. But unattended to one way or the other, claws will do damage. Is declawing these cats off the table because of rigid philosophies?

Cats With Abnormally Fragile Skin

Some cats have genetically fragile skin - skin that is easily torn by claws.

Cat fanciers can be blamed for the suffering of most of these unfortunate designer cats. If you go to the ncbi index in 2018 and search for Devon Rex, you will find 36 articles regarding the unique disease these heavily-inbred cats often suffer from – the high price of human vanity. Sphinx are not far behind. They are highly susceptible to skin disease. (ref1, ref2, ref3, ref4) Animal militants and the AVMA remain hush hush about that too. But In other cats, fragile skin is due to adrenal gland over-activity - something similar to the Cushing’s disease that occurs in dogs. (ref) In some of these cats, their skin fragility was due to high doses of corticosteroids given to address their other health issues. In other instances, fragile skin appears to be the result of disease processes elsewhere in their body. (ref1, ref2, ref3, ref4) In still others, inborn genetic defects. (ref) Dealing with secondary bacterial infections in all of these pets can require periodic antibiotics. With time, those bacteria will become antibiotic-resistant - a threat to the poor cat and to you.
 
Cats with autoimmune skin disease also develop unhealthy skin - just as humans sometimes do. (ref) They too might require periodic antibiotic treatment. Tissue surrounding the claws (the nail beds) often harbors those infections as well. (ref)

Maybe declaw not appropriate for your cat when it faces any of these issues. But the decision should be yours to make without duress. I think your cat would agree.