Today's Veterinary Practice

SEP-OCT 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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CONTINUING EDUCATION SEPTEMBER/OCTOBER 2018 31 Pandora Syndrome in Cats: Diagnosis and Treatment FELINE MEDICINE C. A. Tony Buffington, DVM, PhD, DACVN Clinical Professor, Department of Medicine and Epidemiology, UC Davis School of Veterinary Medicine Emeritus Professor of Veterinary Clinical Sciences, The Ohio State University The term "Pandora syndrome" is based on 4 decades of research and clinical experience 1-4 with cats with chronic lower urinary tract (LUT) signs (i.e., hematuria, pollakiuria, periuria, and stranguria). In 1983, when I began studying LUT signs in cats, they were referred to as "feline urological syndrome" (FUS) 5 or "feline lower urinary tract disease" (FLUTD) 6 and were thought to result from consumption of an improperly formulated diet that contained too much magnesium and that resulted in a urinary pH that promoted formation of a magnesium- ammonium-phosphate (struvite) stone, which was the proximate cause of the LUT signs. 7 It has turned out that nearly all of this explanation was wrong. Struvite urolithiasis was found not to be the most common cause of chronic LUT signs; rather, reducing the magnesium and urine pH (primarily by adding acid to the diet) only succeeded in a shift from the most prevalent stone type being struvite to about half of stone diagnoses being calcium oxalate, and cats continued to suffer from chronic LUT signs without any stone present at all. 8 In the early 1990s, the National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Diseases released a request for proposals for animal models of a chronic pelvic pain syndrome in humans, called interstitial cystitis. My colleagues at Ohio State University and I applied, were funded, and received around 200 donated cats to study. These cats were no longer acceptable as pets because of intractable LUT signs and, alternatively, would have been euthanized by their primary care veterinarian. Two things immediately stood out about these cats. First, many had histories of other health problems; second, all of their signs resolved after entry into our (enriched) cat colony. These and other observations 2 led us to the idea that "feline interstitial cystitis" might be the result of some disorder affecting the urinary bladder rather than being an actual urinary bladder disease. In humans, more comprehensive investigations of patients with interstitial cystitis and a variety of related disorders also resulted in the suggestion of comparable descriptive terms to describe the multiple abnormalities in these patients, such as ''medically unexplained syndrome,'' 9 ''bodily distress syndrome,'' 10 or ''central sensitivity syndrome.'' 11,12 LOWER URINARY SIGNS? Consider the Pandora syndrome. CONTINUING EDUCATION

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