In about a month I am taking my cat (Farofa) over the Atlantic for an operation. She suffers from struvite bladder stones: an ailment that is mainly manifested as hematuria and pain while peeing.

Traditionally this condition is treated with conventional surgery, i.e. cut open belly, cut open bladder, take out stones, sew up. This kind of operations can be performed in prety much all pet surgery centers all over the world. However, it is obviously a crude procedure, that involves considerable risk and considerable (possibly chronic) side-effects. Especially when your cat is young (e.g. mine is only 2 years old) you need to consider that if she suffers from the same condition later on in her life (quite possible) she may need to be cut open again. Obviously not a good thing. So we need to be as savvy as possible when it comes to "cut-belly-open" decisions.

There are better ways to deal with this kind of problem (i.e. bladder stones), alas they are currently performed in very few places in the world. These procedures are usually of the non-interventional sort, i.e. remove the stones without performing any incisions.

For small stones there is a procedure called urohydropropulsion whereby the urethra opening is stretched, the bladder filled with fluid and then the stones either pushed out by squeezing the bladder from the outside or fished out using a micro-basket.

For larger stones there is a hitek procedure called laser lithotripsy. This procedure is also performed on humans and larger animals but its application on small animals is only done in a handful of clinics around the world - none of them in Europe. The Royal Veterinary College in London (most prestigious such establishment in the UK and probably Europe) is currently going through a testing and evaluation phase of the procedure and I was told that they will be offering it some time in the future.

Laser lithotripsy was of particular interest to me as Farofa has at least one bladder stone that is 11mm in size. After doing considerable research on the subject I contacted one of the two US small animal clinics I found online (The Matthew J. Ryan Veterinary Hospital) and eventually came in contact over email with Dr Allyson Berent who very patiently went through the process of explaining to me the available options and suggesting tests that Farofa needed to take before we could determine if she was a suitable patient.

After it was decided that she could take care of her, I started taking care of the trip details. When taking a pet overseas, and specifically from Europe to the US, there are several important questions that you need to consider.

• Can I exit the EU?
• You need either a valid EU passport or a valid ID card issued by one of the EU member states.
• Theoretically you can exit the EU even if you do not have a valid passport (as long as you have a valid ID). However, even theoretically, this does not mean that you will be allowed to enter the country you are travelling to without a valid passport and obviously a visa if a visa is required. In practice however, airlines will not allow you to board a plane unless, to the best of their understanding, you have the necessary documents to be successfully admitted to the country of destination. This is both because of ettiquette as well as because of the fact that airlines get fined by international orgs if they fail to successfully perform these checks.
• For more info see here.
• Can I travel to the US?
• Do I have a valid, non-expired passport?
• In the case of EU passports there is a bit of confusion. Currently some EU passports without a chip (new EU e-passports have a chip that stores biometric info) are considered invalid within the EU even if they have not expired. Greek passports fall in this category, although they are still valid for entry into Greece as long as they are not expired. However, a non-expired old type EU passport with a valid non-expired Visa is acceptable documentation for passing US immigration checks and entering the US if your passport is Italian. As Italy is part of the VISA waiver program, Italians that have the new EU e-passport can travel without a VISA - they do need a VISA however if their passport is of the old type.
• Old type Greek passports (that have been issued before 2006) cannot be used for travelling to the US even if they are not expired and the traveller holds a valid US VISA. The new Greek passports are issued by the Greek Police and the process takes 5 business days if you are in Greece. See here for more info.
• Just for info, in case you live abroad you can apply for the new passport at your closest Greek embassy/consulate. However, the process will take considerably longer. For instance, the Greek consulate general in Milano told me that it would take a month. There is no excuse for that incredible delay. The reason fo it is quite simple: people who work in the diplomacy sector have traditionally been incredible slackers.
• For more info see here.
• Do I need a VISA?
• You do NOT need a VISA if your country of citizenship is one of the countries in the US VISA waiver program or other special treaties. See here for more details.
• If you do need a VISA then you need to either get one or make sure the one you already have is valid and not expired. In case of pre-2006 Greek passports that are not expired and have a valid US VISA on them, they can be used along with your new chip-equipped Greek passport for admittance into the US.
• In all cases contact your local US embassy/consulate at least 15 business days before your trip.
• Can my pet travel to the US? If travelling directly from an EU country to the US then you need to only consider question 1 below. In case your flight is not direct and you go through another EU state you need to consider both question 1 and 2. In case your flight is through some other country it is imperative that you search and find live animal import regulations of that particular country.
• 1. The US regulatory framework for animal import is a bit complex. In order to know if your pet can travel to a specific US destination you need to check with USDA & CDC at both the Federal and State levels.
• CDC
• USDA
• In my case the destination was Philadelphia, PA. By looking at the sites above it seemed that I did not need a health certificate in order to have my pet be imported to the US with PA being the port of entry. However, after a phone call to PA's local USDA offices I found out that my pet DID require a health certificate in English issued no more than 30 days before the day of travel, for it to be admitted in PA. So, ALWAYS check with local authorities; in fact prefer a phone call to web site info that may be stale.
• 2. For your EU pet to be admitted in another EU state it requires a valid EU passport with a record of important vaccinations (more crucially Rabbies) that have not expired, i.e. you have not failed to perform the latest repeat vaccination required.
• This is not all however! More specifically, the UK, Ireland, Malta and Sweden have stricter requirements than the rest of the EU states regarding documents required for pet import/entry. The main (and very significant) difference is that an antibody titration (a test to see if the vaccine has been effective) will need to be carried out by an approved lab before travelling with the pet - there are such labs in all countries but obviously it is a pain in the ass requirement especialy if you live in a city other than the one where the approved lab is. Failing to have this document with you may result in your pet being forcefully quarantined! For details see here.
• So, currently and until some time in 2008, do try to avoid the UK, Ireland, Malta, and Sweden as intermediate stops in your pet-accompanying travels to the US. It can only cause you extra trouble.
• What airline can take me AND my pet to the US?
• I want my pet to travel in the cabin with me. This is highly recommended as pets travelling all alone for a long time may suffer depression, claustrophobia, injure themselves trying to escape from their boxes in fear, not to mention that the travelling conditions (pressure, temperature, noise, etc.) in the bay may be suboptimal (although they say that they are not). Also remember that your animal will have to stay where it did its peepee and kaka (something that they do not like at all). There is another frightening possibility to consider: the pilot forgetting to turn on environmental control at the animal bay (they only turn it on if they are successfully informed of the presence of animals there). Always make sure that your pet travelling reservations is done before you pay for the ticket. If your pet is particularly afraid of travelling (and gets edgy, or restless) you may consider using a mild-sedative like acepromazine. However, use of tranquilizers and sedatives (even mild ones) during air-travel is not recommended and should only be considered as a last resort. Some petting, love/affection giving and sweet talking can do a world of good. Just try it before you try anything else.
• Airlines that accept pets as carry-on (i.e. in cabin) baggage in transatlantic/overseas flights are:
• United
• Continental
• NorthWest
• Air-France (the one I used)
• KLM
• Lufthansa, which, in particular, seems to be the most-welcoming and flexible when it comes to pet travel. They mention on their site that they will offer you a pet box free of charge if yours does not meet the allowable travel box specs (size and type).
• I prefer that my pet travels in the airplane's cargo bay as checked-in baggage or cargo.
• Most other major airlines offer this option. Airlines that I have checked with and know they do:
• All airlines above that also offer in-cabin pet travel.
• BA
• Delta
• Airlines that do not accept pets on transatlantic/overseas flights either as carry-on baggage or as checked-in baggage/cargo (BOOOOOOO!!) are:
• US Airways
• American Airlines