WellCat for life IS A TRADEMARK OF THE felineadvisorybureau 2008 © FAB In collaboration with
www.hillspet.com www.petplan.co.uk www.merial.com Printed by Blackmore Ltd, Shaftesbury, on environmentally friendly paper ISBN 978-0-9558698-0-8
A guide to engaging your clients in a lifelong
partnership
WellCat for life
An initiative from the felineadvisorybureau
A guide to engaging your c Thank you to all those who have contributed to Wellcat for life – in particular to Andrea Harvey (FAB lecturer, University of Bristol); the FAB feline expert and behaviour panels; and Lisa Milella and Norman Johnston for input into the dentistry pages. Photographs have been supplied by John Conibear, of the University of Bristol, Warren Photographic, Neil Hepworth and Julie Fernandez, and Castle Vets Pet Healthcare Centre, Reading.
contents 1 2 3 5 6 8 12 14 16 17
Well overdue Well worth it? How does it work? Life stages redefined Routine health checks . . . . . . and a partnership of care Life stage focus History taking Physical examination Breed-related disorders Obesity and weight management
18 19 21 22 24 26 27 28 29 31 32
Preventing behaviour problems Routine preventive care Blood pressure Feline dentistry Laboratory tests Rational treatment protocols Well insured? Food and water intake Euthanasia – best practice 50 years of helping cats Practice membership
The Feline Advisory Bureau is a company limited by guarantee, registered in England and Wales, no: 6002684. Registered Charity no:1117342 Registered office: Taeselbury, High Street, Tisbury, Wiltshire SP3 6LD
clients in a lifelong partnership
WellCat for life well overdue YOU MAY HAVE heard the urban myth about the 50% or so of cats in the UK that never see a vet. The figure might not be entirely accurate but the premise is, sadly, true. We all know about the kittens that attend the practice regularly until their first birthday and then drift away slowly, never to be seen again unless they fall ill, and we all recognise – perhaps in ourselves – the well-meaning, but distracted, cat owners who fully intend to do everything properly but, somehow, life gets in the way. These are the realities of cat ownership and the relationship that cat owners have with their veterinary practices. Some of the drivers for these behaviours can be found in ignorance of what is entailed in the responsibility of owning and caring for a cat; others may be found in a lack of commitment. However, most cat owners really do want to ‘do the right thing’ for their cats. So what is involved in ‘doing the right thing’? How can vets in practice ensure that the cats under their care receive the best possible attention to their health throughout their lives? The WellCat for life programme sets out a clear partnership of care between the vet and the cat’s owner – showing what should be expected of each party and when the important milestones are likely to occur. It focuses on maintaining and managing the cat’s health rather than just attending to its sickness. It aims to provide a clear platform for vets and owners alike to ensure that cats can enjoy long, happy, healthy lives. FAB recognises that not every owner will meet every opportunity to follow the right course and that, while some owners will do absolutely everything they are asked, others will do so reluctantly or, at best, sporadically. To address this, the WellCat for life programme includes both educational and motivational materials for owners of varying shades of commitment, as well as this comprehensive guide for veterinary professionals. The aim of the WellCat for life veterinary handbook is to focus on the everyday common things in practice – for example, routine checks and preventive care, problems like dental disease, renal failure and obesity, and when to perform and how to interpret basic laboratory tests. It also provides some tips to pass on to your clients to improve understanding and compliance when changing their cat’s diet or increasing its water intake, for example. Some important considerations are highlighted regarding drugs that are used every day in general practice (antibiotics and corticosteroids) – facts that are easy to forget or overlook. Finally, there are some guidelines on what is, sadly, one of the most commonly performed and important procedures in general practice, euthanasia.
WellCat 1
WellCat for life
well worth it?
NOT SO LONG AGO, many practices charged a differential consulting fee for cats. Nowadays the importance of cats to every small animal practice cannot be ignored. There are around 9 million cats in the UK and a little over a quarter of the population owns a cat. Over 6 million households own at least one cat and, of these, 2·5 million own more than one. That’s a lot of cats!
‘We talk with much greater confidence, our understanding of cat needs is greater, clients pick up on our greater interest and knowledge. We know that our regular cat clients talk to their friends and recommend us as a practice that is good with cats.’
Each year, around 500,000 kittens are born, around 90% of which are moggies. While the average lifespan of a cat is about 13 or 14 years, many will live into their late teens and some beyond 20 years. Like the human population, the feline population is an ageing one, with almost half the cats in the UK aged 8 years+.
In contrast to dogs, around 60% of cats cost their owners nothing to obtain, but this doesn’t diminish the strength of feeling that so many people have for their cats. Indeed, 10% of people would rather spend time with their cat than with anyone else (intriguingly, this figure is higher still in Scotland!) and one-third of owners acquired their cat expressly for companionship. Over the years, the veterinary profession and animal charities have done an excellent job of encouraging neutering and, today, around 90% of cats in the UK are neutered. However, there are probably more than 4 million cats that are currently unvaccinated and the rate of revaccination decreases with age. In a survey of committed cat owners, 37% admitted that they had not visited the vet in the past 12 months and, inexorably, the source of information about pet welfare issues has shifted from the vet – with 55% seeking information from other sources. Most worryingly, 37% of owners said they would consult other sources, rather than the vet, for information concerning their pet’s health.
‘There is greater readiness to take part in proactive and preventive healthcare. This probably stems from our own changed approach – we, in turn, are more proactive in promoting it to the clients.’
‘Cats are much calmer – they chill out, settle and life is much easier.’
Clearly, the cat represents a considerable opportunity to veterinary practice. Recent experience with FAB’s Cat Friendly Practice programme has demonstrated that increased knowledge and understanding of cats pays real dividends at practice level, as these quotations from some of those involved illustrate.
If WellCat for life succeeds in making life much easier, it’ll be well worth it! 2 WellCat
How does WellCat for life
work?
CAT OWNERS TURN to a variety of sources for information on their cats’ health. Ideally this would always be the vet, but in these days of internet information and where other organisations and companies are becoming better qualified on animal care, there is a range of ‘gatekeepers’ who will advise owners. Different points of contact assume different degrees of importance, depending on the cat’s age and perceived state of health, and so WellCat for life seeks to make contact with as many cat owners as possible through this range of influences – the vet, the pet shop, the cattery, the rescue organisation, the breeder and, where appropriate, the pharmacy. The initiative is not just aimed at people who already go to the vet but hopes to stimulate interest in owners who do not usually go to the vet by encouraging them to notice their cat’s weight and age – and, from there, to think about its state of health. This opportunity for other cat professionals to provide owners with authoritative materials for use throughout their cats’ lives is part of a process designed ultimately to encourage a higher percentage of cat owners to consult the veterinary practice in the management of their cats’ health. A combination of printed materials and online resources make up a comprehensive WellCat for life kit, providing a single set of standards with a consistent message.
WellCat for life kit The WellCatlog will WellCatlog. This is a complementary also be available from owners’ booklet that can be personalised selected catteries, with the practice stamp on the back cover breeders, rescue To help keep your cat safe and healthy and given to clients with cats of any age. It organisations and pet is just as suitable for those with new kittens shops with the aim of driving owners to the coming into the practice, as for those with veterinary practice old cats requiring close veterinary attention. In its 36 pages, it discusses the health and care requirements of cats throughout their lives. It asks owners to get involved in preventive A guide to engaging your clients in a lifelong partnership healthcare by explaining what you, as their vet, will be checking in their cat and encouraging them to record various health parameters. Owners are warned of disease risks associated with different life stages and advised of the all-toooften subtle signs to be vigilant for. Moreover, they are asked briefly to log details of any episodes of sickness in their cats that are severe enough to warrant a trip to the vet. FAB is asking owners to send in their WellCatlog when their cat dies, and the expectation is that, in time, an invaluable bank of data will be built up that will help direct further developments in feline veterinary care. With the owner’s permission, FAB may, at a later date, follow up information recorded in the WellCatlog with the relevant veterinary practice(s), as required.
your WellCatlog
WellCat for life
WellCat for life veterinary handbook. This comprehensive guide outlines a gold standard of preventive care for cats and has been developed by the FAB feline expert panel. It is the cornerstone of the WellCat for life programme and has been designed to be used alongside the accompanying, more consumer-oriented, materials.
An initiative from the felineadvisorybureau
WellCat 3
How does WellCat for life
work?
has made a great leap forward in keeping your cat safe and healthy
WellCat for life Go to www.fabcats.org or ask here for further details
WellCat posters. Designed for veterinary practice waiting rooms, catteries, breeders, pet shops and pharmacies, the poster encourages clients to ask about the WellCat for life programme or to consult FAB’s website, www.fabcats.org, for more information. Wheel of Furtune. Aimed at owners who may not have thought much about their cat’s health, and available from pet shops and other outlets, the WellCat Wheel of Furtune introduces the concept of life stage and body condition in a light-hearted way. By rotating the wheel, owners can calculate how old their cat is in human terms and determine whether it is too fat, too thin or about right. Although principally intended to encourage owners who may not go to the vet to bring their cat in for a check-up, it could also be used by veterinary practices to raise awareness of these fundamental issues. www.fabcats.org/wellcat/for_life. The WellCat for life pages on FAB’s website, at www.fabcats.org/wellcat/for_life, provide supplementary information and downloads to support the programme – and, in time, will carry updates and feedback.
WellCat club
WellCatclub. Also being launched as part of the WellCat for life programme is the WellCatclub, an online resource aimed at the more committed cat owner and available at www.wellcat.org. It gives owners the opportunity to sign up and receive more information, to feed back opinions on feline-related matters and be involved in surveys. In the future, owners will be able to input their cats’ health data directly online.
furtherinfo
FAB disseminates a wide range of information on feline topics to both vets and cat owners in a variety of ways. Relevant information sources are referred to throughout this veterinary handbook.
For vets
FAB Clinical Protocols. Over 20 protocols written by members of FAB’s feline expert panel are available in the veterinary pages of FAB’s website – at www.fabvets.org. They can be downloaded for free by FAB practice members (see page 32 for details of practice membership) or for a fee by other veterinary personnel FAB Veterinary Factsheets. Information sheets for vets are being developed and will shortly be freely available at www.fabvets.org Cat Friendly Practice. Information for vets on creating a cat friendly practice is freely available at www.fabcats.org/ catfriendlypractice/vets.html Journal of Feline Medicine and Surgery. From 2009, JFMS will include 6 extra issues comprising practice-oriented clinical review articles on feline medical and surgical topics, as well as ongoing information on WellCat for life 4 WellCat
For clients
FAB Owner Info Sheets. Almost 500 pages of information on feline disease, behaviour, care and management is freely available to cat owners on FAB’s website, www.fabcats.org. This resource is being continually expanded and updated FAB breeder information. Information aimed specifically at cat breeders, covering feline health and inherited disorders, breeding, and kitten care/health, is available at www.fabcats. org/breeders Cat Friendly Practice. A range of leaflets for clients can be downloaded from www.fabcats.org/catfriendlypractice/owners.html. Printed copies may also be purchased for distribution in the practice (see www.fabcats.org/catfriendlypractice/ vet_leaflets.html) CatCare. FAB’s newly designed quarterly journal provides a host of information to support cat professionals and highly dedicated cat owners
Life stages redefined EARLY ON IN THE PLANNING of WellCat for life, it became clear that the cat’s life stages were not well defined. The terms senior and geriatric were often used interchangeably, the age at which a cat was considered to be senior or geriatric was not consistent, and the threshold for ‘old age’ was commonly quoted as being around 8 years old. Clearly, however, cats often live well into their teens (some beyond), and many 8-year-old cats are hardly geriatric! The first step, therefore, in creating a lifelong healthcare programme was to redefine feline life stages into more meaningful and appropriate categories, taking into account how
To encourage owners to think about the age of their cat and what it means in terms of the risks of certain diseases, what they should look out for, and the preventive healthcare that should be discussed with their veterinary surgeon at each life stage, the cat’s age is also expressed in terms of the human equivalent.
Life stage
Age of cat
Human equivalent
Kitten
0 – 1 month 2 – 3 months 4 months 6 months
0 – 1 year 2 – 4 years 6 – 8 years 10 years
7 months 12 months 18 months 2 years
12 years 15 years 21 years 24 years
3 4 5 6
28 32 36 40
7 8 9 10
44 48 52 56
11 12 13 14
60 64 68 72
15 16 17 18 19 20 21
76 80 84 88 92 96 100
birth to 6 months Tigger 3 months old
Junior 7 months to 2 years Sugar 13 months old
Prime 3 years to 6 years Rosie 3 years old
Mature 7 years to 10 years Nemo 8 years old
Senior 11 years to 14 years George 13 years old
Geriatric 15 years+
Chinarose 16 years old
cats mature both physically and behaviourally and the onset of common changes and disease problems. We have named these kitten, junior, prime, mature, senior and geriatric, as set out in the chart below, which also appears in the owners’ WellCatlog.
WellCat 5
Routine health checks . . . ONE OF THE PRINCIPAL aims of WellCat for life is to lay down a ‘gold standard’ for what routine monitoring checks are advisable, and when these should be performed throughout life. By educating owners about the importance of preventive care, and of routine health checks in picking up early signs of disease, and by providing a standard for veterinary surgeons to work with, improvements will hopefully be seen in client uptake and compliance and, in turn, in the overall health of cats. The WellCatlog contains the following WellCat Health Chart, which recommends when it is advisable for healthy cats to undergo routine physical examination, preventive healthcare, weighing and body condition scoring, blood pressure measurement, urinalysis and haematology/biochemistry. (Clearly the level of monitoring will need to be tailored in a sick cat.) The WellCatlog also discusses what is involved in a routine physical examination, health issues at different life stages and what further tests may be necessary and why. The aim is to demystify the processes and make things as stress-free as possible.
Kitten Age
Junior
2-3 months 6 months 12 months
An important theme that runs throughout is the cat’s extraordinary ability to hide signs of illness – any signs it does show are usually quite subtle. This is because in the wild the cat can be a prey animal as well as a predator – if it shows signs of weakness it may attract attention. And, unlike the dog, which is a pack animal, the solitary cat has nobody to rely on but itself. The idea, generally, is that if owners can be more involved with monitoring their cats’ health, more health issues will be detected earlier. To this end, the WellCatlog discusses elements in a cat’s history that owners should inform the vet of at any health checks, and what changes in appearance, behaviour, mobility and demeanour they should look out for.
Physical examination, bodyweight and body condition scoring
The WellCat for life programme advises an annual routine check-up for physical examination, weighing and body condition scoring (see page 17), and for reviewing preventive healthcare, up until a cat is 10 years of age, to fit in with routine booster vaccinations. Thereafter, it is more likely that the health
Prime
Mature
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 y
Insert date(s) of examination(s) Physical examination (including dental exam)
Weight/body condition score
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Insert bodyweight 1 Insert bodyweight 2 (where appropriate)
Insert body condition score 1 Insert body condition score 2 (where appropriate)
Discuss preventive care with vet (vaccination, flea and worm treatments)
Tick if given a vaccination Blood pressure measurement
Insert blood pressure 1 Insert blood pressure 2 (where appropriate)
Urine analysis Insert urine specific gravity 1 Insert urine specific gravity 2 (where appropriate)
Blood tests Tick if blood tests performed Key: Once a year
6 WellCat
/ Once or twice a year
Twice a year
– Not usually necessary at this age
. . . and a partnership of care status of a cat could change more quickly, and so once or twice yearly checks are recommended for cats in the 11- to 14-year-old bracket, and biannual checks for those 15 years and above.
Blood pressure measurement and urinalysis
Annual routine blood pressure monitoring and urinalysis is recommended when cats reach the mature life stage (7 years of age upwards). Above 8 or 9 years of age, the risk of hypertension starts to increase, and early detection is vital to prevent complications of hypertension, such as hypertensive retinopathy and blindess. Starting blood pressure monitoring at 7 years of age allows some baseline measurements to be obtained before the cat reaches the more ‘at risk’ ages. Similarly, commencing routine urinalysis when cats reach maturity, a few years before a decline in renal function might be expected, provides some individual baseline measurements to allow detection of any changes and monitoring of trends in the later years. It is also useful for
Senior
picking up diabetes mellitus as early as possible in this ‘at risk’ age group.
Blood profiles
Performing ‘blood profiles’ as a routine when cats reach the senior life stage (from 11 years upwards), will help to detect early evidence of some diseases as soon as possible.
WellCat Health Chart
Geriatric
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
/
/
/
/
/
/
/
/
/
/
/
/
These are guidelines for healthy cats. Checks may need to be made earlier or more often if your cat is unwell WellCat 7
Life stage focus Kitten
Every opportunity needs to be taken in a kitten’s first few visits to bond the client to the practice
(0 to 6 months)
Most cat owners will bring their kitten to the veterinary surgery for first vaccinations and neutering, but often they do not return until the cat becomes ill much later in life. It is therefore important not to assume that, just because a kitten presents for its first vaccination, its owners will continue to bring it in for annual health checks and boosters. Instead every opportunity needs to be taken in these first visits to bond the client to the practice and educate them about the importance of a lifelong preventive healthcare scheme. A great deal of information needs to be imparted in the first few visits (see ‘points to cover’ below) to equip the owner with what they need to ensure the health and wellbeing of their cat for the next year, and to ensure they return their cat for its health check at 1 and 2 years of age.
Traditionally neutering has been carried out at around 6 months of age, but recent guidelines suggest that 4 months of age may be more appropriate to ensure that precocious kittens do not become pregnant at or before 6 months. This will also help to keep contact with the client by booking in when final vaccinations are complete. Concerns regarding the risks of anaesthesia, and the impact on the cat’s behavioural development, growth and physical development, have all received attention, with no evidence being found to suggest that earlier neutering has any negative impacts. For a fuller discussion of these issues, see The Cat Group’s policy statement on the timing of neutering at www.fabcats.org/cat_group/policy_ statements/neut.html
compliance with the preventive healthcare scheme over the ‘prime’ years, as this is the time when clients are most likely to stop bringing their cat to the vet.
It is important to make preventive healthcare visits worthwhile for clients with junior cats, to continue bonding them to the practice and ensure their ongoing compliance with preventive healthcare
Junior
(7 months to 2 years)
If your clients have brought their cats back to your clinic for their first and second year boosters, congratulations! You have managed to start bonding them to the practice. It is important to make these visits worthwhile to ensure their continued
In the case of owners who have just obtained a junior cat from a rescue organisation, relevant issues that would have been discussed at first vaccination or neutering may need to be discussed at this stage instead. Ensure you don’t miss this vital opportunity to provide these owners with the information they need to keep their cat healthy, and to bond them to your practice.
Prime
(3 to 6 years)
An annual review of preventive healthcare is just as important for cats in their prime: don’t assume that their lifestyle and preventive healthcare requirements have remained unchanged. When cats reach their prime, many clients don’t return them for annual boosters and health checks – which is why early bonding to the practice is so important
points to cover
In addition to discussions on preventive healthcare, new kitten owners and those who have acquired rescue cats should be advised about: Diet – the importance of a balanced diet formulated for growth, what to look out for when buying cat foods, what constitutes a complete diet versus complementary foods, and the difference between life stage diets Introductions – to other cats and/or dogs in the household, if this is relevant 8 WellCat
Cats become socially mature in their prime and therefore this is usually the stage at which most behavioural problems and behaviour-related diseases (eg, idiopathic cystitis) will become evident. Clearly, detecting and addressing any issues at an early stage, which might otherwise
Clinical signs of illness – the WellCatlog emphasises the importance of owner vigilance given the often subtle signs exhibited by sick cats Stress-free trips to the vet – again the WellCatlog discusses how trips to the vet can be made as pleasant as possible. Further advice can be found in the Cat Friendly Practice section of www.fabcats.org Inherited diseases – for pedigree cats, any inherited diseases encountered in the breed and what to look out for (see www.fabcats. org/breeders/inherited_disorders)
furtherinfo
At the time of neutering particular attention should be paid in the physical examination to the presence/absence of descended testes and other congenital defects (eg, umbilical hernia, cleft palate and heart murmurs). It is important that the recording of bodyweight and body condition score is initiated and an assessment of the cat’s growth is made. It is also important to review preventive healthcare at the time of neutering. For example, some owners that initially said their cat was going to be kept indoors and opted not to have FeLV vaccination may have changed their minds and decided to let the cat outdoors once neutered. Obviously this will impact on the advice that needs to be given regarding FeLV vaccination. Dietary advice again needs to be reviewed, and
For all junior cats, preventive healthcare and diet should be reviewed. Hopefully most cats will be relatively healthy at this life stage. The most common problems likely to be encountered are related to infectious diseases, cat bite related infections, dietary indiscretion and road traffic accidents. Nevertheless, remember that young cats can develop serious diseases, too, such as heart disease and infectious disease (eg, feline infectious peritonitis); even some neoplastic diseases like lymphoma can frequently occur in this age group of cats. Considering that cats
lead to behavioural problems later on, is preferable. In pedigree cats this may be the age group that some inherited diseases become evident, such as polycystic kidney disease. Be aware of specific diseases to look out for in certain breeds – see page 16. Obesity will become more common in this age group, too, and here again prevention is much
Developmental periods – what owners should expect. An understanding of normal behaviour in cats will help to prevent behavioural problems such as aggression, elimination behaviour and scratching Neutering – if and when to neuter (see www.fabcats. org/cat_group/policy_statements/neut.html) Pet insurance – see page 27
discussions regarding feeding to prevent obesity are also well worthwhile. Other aspects of care that need to be explored around this time are the pros and cons of an indoor versus indoor/outdoor lifestyle and, particularly for outdoor cats, microchipping, cat flaps, and choice of collars to ensure that only safety collars are used. If the cat is kept indoors exclusively, then environmental enrichment should be discussed in order to minimise the risk of behavioural problems and related disease such as idiopathic cystitis (see page 18). Further advice is available in FAB’s book, ‘Essential Cattitude’ (see page 19). Another useful resource is The Indoor Cat Initiative, run by Tony Buffington and colleagues at Ohio State University – www.vet.ohio-state.edu/indoorcat
at www.fabcats.org FAB Owner Info Sheets Neutering your cat Caring for your kitten Hand rearing kittens Introducing your cat to other cats and dogs
are so good at hiding signs of illness, any concerns that the owner has regarding their cat’s health should be taken seriously to maximise the chance of detecting serious problems early on. Thorough clinical histories and physical examination at these routine checks can help to pick up problems early on. The WellCatlog provides questions that owners should ask themselves to alert them to any changes in their cat’s normal habits.
better than cure! Regular body condition scoring, weighing and dietary advice will help to detect weight gain early on so that prompt action can be taken to prevent obesity. Owner compliance with dietary advice will be improved by emphasising how common obesity is and how difficult weight loss is to achieve once obesity occurs, and discussing the associated risks, such as osteoarthritis, diabetes mellitus, hepatic lipidosis and cardiovascular disease, as well as increased anaesthetic and surgical risks.
health plan for life The WellCat Health Chart on pages 6 and 7 provides general guidelines on how often various parameters should be checked in healthy cats at each of the life stages. Clearly, the approach will need to be individualised for each cat, particularly if it is unwell.
WellCat 9
Life stage focus Mature, senior and geriatric (7 to 10 years, 11 to 14 years and 15 years+)
Mature cats may well appear as though they’re still in their prime, but they start to become at increased risk of ‘older cat’ diseases. More vigilant monitoring is required on the part of vet and owner alike
It is important to appreciate and consider various changes that occur with advancing age whenever an older cat is being assessed, investigated or managed. Owners also need to be made aware of these changes in order to provide the best care for their ageing feline friends. Senses. Vision may decline due to retinal changes, nuclear sclerosis (lens ageing) and iris atrophy, making the cat sensitive to bright light. Loss of hearing is common, often caused by a loss of spiral ganglion cells. Affected cats may be easily startled and cry during the night or when left alone.
Most senior cats are not perceived by their owners as being elderly. Ageing changes are often subclinical, and may only be apparent to the owner as increased sleeping or decreased activity
It will come as no surprise that chronic renal disease, hyperthyroidism, diabetes mellitus, osteoarthritis and neoplasia are recognised as being the ‘top 5’ significant conditions of mature, senior and geriatric cats. Here are some priorities and pointers for their day-to-day management
older cat diseases Chronic renal disease
Priorities for assessment Urea/creatinine (always interpret with urine specific gravity) Electrolytes (Na+/K+/PO4–/Ca2+) Proteins (albumin/globulins) Haematology Urinalysis, including urinary protein:creatinine ratio and urine culture Blood pressure Considerations when managing cases Correction of dehydration and optimisation of fluid intake. Initially intravenous fluids may be required, followed by subcutaneous fluids or increased oral fluid intake (see page 28) Dietary modification (restricted phosphate and protein) Oral potassium supplementation Oral phosphate binders (eg, aluminium hydroxide) Treatment of vomiting/nausea – antiemetics (eg, metoclopramide) and gastroprotectants (eg, ranitidine, sucralfate) Treatment of hypertension (amplodipine, benazepril) Appetite stimulation (eg, cyproheptadine, mirtazepine)
10 WellCat
A cat’s sense of taste may reduce as it ages and therefore food preferences may change. Sense of smell also reduces in older age, which may contribute to any loss of appetite. Warming food to enhance the aroma may help. Cardiovascular and respiratory system. Ageing results in loss of lung compliance and fatigue of respiratory muscles, with a consequent reduction in oxygenation. Cardiac disease is also not uncommon in older cats – both primary cardiomyopathies and secondary cardiac changes associated with ‘old cat’ diseases such as hyperthyroidism and hypertension. Gastrointestinal system. Gastrointestinal function may decline, necessitating a highly digestible, nutrient-dense diet. Vomiting and diarrhoea can commonly result from systemic (eg, hyperthyroidism) or neoplastic disease (eg, gastrointestinal lymphoma). Mild constipation is also common in older cats, often resulting from a combination of factors, such as reduced colonic motility, mild dehydration, or reluctance to use the litter tray/go outdoors (eg, due to osteoarthritis). Oral cavity. Periodontal disease, odontoclastic resorption lesions and tooth loss are common and can contribute to inappetence, halitosis and
Treatment of urinary tract infection Treatment of proteinuria (benazepril)
Hyperthyroidism
Considerations when managing cases See page 24 for important laboratory considerations Remember to assess the patient for hyperthyroid complications (eg, hypertension, heart disease) and concurrent disease when deciding on appropriate treatment options If considering surgery, discuss with the owner the possibility of ectopic thyroid tissue, risks of incomplete removal, and complications of surgery (eg, hypoparathyroidism) When considering medical therapy, discuss potential side effects of treatment (eg, vomiting, anorexia, hepatopathies, facial pruritus and haematological disorders), and ensure appropriate monitoring for side effects Consider discussing referral for assessment ± radioactive iodine treatment, where appropriate Consider impact of treating hyperthyroidism on any pre-existing renal disease and ensure adequate monitoring
Diabetes mellitus
Diabetes mellitus is most likely to develop as cats reach the mature stage of life, and so particular
furtherinfo
at www.fabvets.org
+) dysphagia. Oral cavity neoplasia also occurs in the older cat and can be easy missed without thorough examinations. Musculoskeletal system. Muscle mass reduces with age and can result in weakness. Bone density and cartilage quality also diminishes, contributing to the development of osteoarthritis. Renal system. With age the kidneys reduce in size and weight, glomerular filtration rate reduces and the renal tubules atrophy. This leads to the formation of dilute urine, which in turn predisposes to urinary tract infection. Incontinence can be encountered in older cats; so too can inappropriate urination as a result of behavioural changes. Central nervous system. Ageing changes within the central nervous system may result in behavioural change (eg, cognitive dysfunction leading to apparent senility). This may leave the cat disorientated and reluctant to interact with family members and other pets.
attention should be directed at looking for early signs of diabetes, especially in at-risk cats. Risk factors Obesity Indoor lifestyle Corticosteroid/megestrol acetate treatment Breed – Burmese cats are predisposed Sex – male cats are predisposed Regular urinalysis to detect glucosuria is warranted in older cats displaying one or more of these risk factors.
Osteoarthritis
Osteoarthritis is now known to be much more common in cats than previously thought. The clinical signs are often very subtle and radiographic changes may be found incidentally. Cats rarely present with overt lameness and the clinician must probe for important historical information reflecting impaired mobility (see page 12). Considerations when managing cases Environmental changes (see WellCatlog, page 28, for further information) Weight loss, if required Analgesia Dietary management (see page 28)
Skin and claws. The skin of older cats becomes thin and lacking in elasticity, which can make assessment of hydration difficult. Reduced grooming can result in a poor haircoat. Claws become brittle and overgrow due to reduced activity, requiring regular trimming. Immune system. Immune function may decline with age, leading to increased susceptibility to infection.
FAB Clinical Protocols Hyperthyroidism 1: Radioiodine therapy Hyperthyroidism 2: With chronic renal failure Hyperthyroidism 3: Post operative hypoparathyroidism Subcutaneous fluid therapy COP chemotherapy for feline lymphoma FAB Veterinary Factsheets Care of the older cat Osteoarthritis in cats Diabetes NSAIDs
furtherinfo
With geriatric cats, the ageing changes are much more apparent to the owner, who can clearly appreciate that their cat has become old
Neoplasia
Neoplasia is inevitably diagnosed more frequently in older cats. Fortunately, developments in oncology mean that some forms of neoplasia can be managed, allowing the cat to maintain a good quality of life with relatively few side effects. If a neoplastic process is suspected it is obviously very important that an accurate diagnosis is reached using cytology and/or histopathology. Considerations when managing cases Surgical resection of suspected neoplastic masses should be carefully planned to achieve the best possible result, as the first surgery offers the greatest prospect of complete removal. Referral to a specialist may be required Effective staging will allow for treatment planning and will provide information on prognosis Owners should be made aware of the prognosis and costs involved before starting any treatment Discussion regarding euthanasia is appropriate before the situation arises An oncologist should be contacted for further advice if there is any uncertainty about treatment options
at www.fabcats.org FAB Owner Info Sheets The overweight cat Chronic kidney (renal) failure in cats Giving subcutaneous fluids to cats – an owner’s guide Caring for the elderly cat Hyperthyroidism in cats Managing the diabetic cat Arthritis in cats Cancer in cats (1) – what is it and what are the common cancers in cats? Cancer in cats (2) – how can cats be treated? High blood pressure (hypertension) in cats Constipation in the cat
Pharmacological considerations
Ageing can affect the absorption, distribution, metabolism and elimination of drugs. Absorption from the gastrointestinal tract may be reduced, as may absorption from subcutaneous and intramuscular sites. Changes in the proportion of body fat may affect drug distribution, and reduced renal and hepatic function can affect transformation and elimination of drugs. Older cats receiving several medications may suffer from drug interactions. Drug doses should be reduced in animals with known renal or hepatic disease.
WellCat 11
History taking behavioural checklist
Does your cat urinate or defecate outside the litter tray? Does your cat spray? (Spraying occurs when a cat backs up to a vertical surface, kneads with its feet, and flicks the tail tip while projecting urine) Does your cat show signs of aggression to people, including hissing, biting or scratching? If so, are these directed towards any specific family members? To strangers? Does your cat exhibit any fearful behaviours that concern you? Does your cat show any destructive behaviours, such as scratching or chewing objects in the home? Has there been any change in your cat’s behaviours or disposition? Does your cat have any problematic interactions with other cats or pets in the household or neighbourhood? (see page 18)
THE WellCat for life clinical history form, shown opposite, can be photocopied, or downloaded from www.fabcats. org/wellcat/for_life, and used in the practice to make collecting full standard histories easier. Practices may choose to hand these forms to owners to fill out as far as possible before bringing their cat in, or they may organise for a nurse or member of support staff to collect the history using the form. To get a full picture of the cat’s state of health, it is vital not to overlook mobility and behaviour.
Questions relating to mobility
Once cats reach the mature life stage, the risks of osteoarthritis begin to increase. The checklist below will help to detect early signs. It is based on a questionnaire, produced by Hill’s Pet Nutrition, which is included in the WellCatlog to encourage owners to think about and evaluate their cat’s mobility; owners are asked to consider whether their cat shows these various signs ‘all of the time’, ‘some of the time’ or ‘none of the time’.
Questions relating to behaviour
There are a number of questions (see left) that can usefully be asked at routine health checks to pick up behavioural issues as early as possible. Equally they will be helpful in cats with suspected behavioural problems.
mobility checklist
Note that many owners will not recognise signs of conflict in their cat(s) – hence the inclusion of the last question on problematic interactions. For further discussion on this aspect, and some pointers on which to base questions about the cat’s environment, see page 18. It is important to be aware that medical and behavioural issues are often closely related. For example, a cat that is inappropriately urinating may have a condition that is associated with this behaviour, such as idiopathic cystitis, or arthritis which is making it difficult to get into the litter tray. Similarly, a cat that presents with anorexia and lethargy may have an underlying medical problem; alternatively it may be stressed by changes in its environment.
Questions relating to specific problems
If the cat is showing any specific clinical signs (eg, vomiting or coughing), the owner will need more detailed questioning. Ask about: Duration of clinical signs Onset – acute versus chronic Frequency of clinical signs Features/timing (eg, is vomiting always after food? is the cough productive?) Whether signs are getting worse, better or remaining the same Any improvement with medication Presence of other clinical signs – coughing, sneezing, nasal discharge, vomiting, diarrhoea, inappetence, weight loss, and so on
Does your cat sleep more and/or is it less active? Is your cat less willing to jump up or down? Will your cat only jump up or down from lower heights? Does your cat sometimes show signs of stiffness when walking or running? Is your cat more reluctant to come and greet you or interact with you? Does your cat play with other animals or toys less? Does your cat have a poor coat and/or spend less time grooming? Overall is your cat less agile? Does your cat show signs of lameness or limping? Does your cat have more accidents outside the litter tray? Does your cat have difficulty getting in or out of the cat flap? Does your cat have difficulty going up or down stairs?
12 WellCat
Clinical history
WellCat for life
Date: ................. Case number: ................... Owner’s name: .....................................................
Cat’s name: ........................................... Clinician: ................................................
BACKGROUND Age: .......................
O
Acquired from:
O
Other cats:
Sex: ...............
O
Breeder
O
No
Yes
Breed: ...................................................
O
Rescue centre
Time in owner’s possession: ..................................
Other: .........................................................................................................
How many? .....................
Any problems? ..............................................................................
HABITAT Environment: Litter tray: Cat fighting: Hunting: Access to toxins:
O O O O O
O O O O O
Indoor No No No No
Indoor/Outdoor Yes
O
Limited outdoors
O
In at night
O
Outdoor only
Type of litter used: .........................................................................................................
Yes ............................................................................................................................................... Yes ................................................................................................................................................ Yes ................................................................................................................................................
NUTRITION Last fed: ........................................ am/pm Diet:
O
O
Dry cat food
O
Wet cat food
Both
O
Other ...................................................................................................
Food type/brand normally fed: .................................................................................................................................................................. Favourite foods or dislikes: .......................................................................................................................................................................
ROUTINE PREVENTIVE HEALTHCARE Vaccinations:
O
O
FHV/FCV/FPV
Last vaccination given:
O
FeLV
≤15 months
O
O
<36 months
>36 months
O
Never
O
Unknown
Worming (which product and when): ........................................................................................................................................................ Flea treatment (which product and when): ................................................................................................................................................ Retrovirus status:
O
FeLV+
O
FeLV–
O
FIV+
O
FIV–
When: ...............................................................................
PREVIOUS PROBLEMS ................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ...................................................................................................................................................................................................................
CURRENT PROBLEMS ................................................................................................................................................................................................................... ................................................................................................................................................................................................................... ...................................................................................................................................................................................................................
CURRENT STATUS Attitude/demeanour: ................................................................................................................................................................................. Appetite: ........................................................................................
Thirst: ...........................................................................................
Urination: .......................................................................................
Defecation: ...................................................................................
Any vomiting? ........................................................................................................................................................................................... Respiratory signs (coughing, breathing difficulty, sneezing, nasal discharge): ............................................................................................ Mobility: .................................................................................................................................................................................................... Behaviour: ................................................................................................................................................................................................
Additional clinical history forms can be downloaded from www.fabcats.org/wellcat/veterinary WellCat 13
Physical examination learning from practice
IT IS ALL well and good knowing what should be done in every physical examination, but whether the cat will allow a thorough examination is another question! Assuming your patient has arrived on the consulting room table without too much anxiety, the way in which you go about the physical examination will determine whether you glean a great deal of useful information – or little more than the size of its canine teeth, the sharpness of its claws and the sound of growling through a stethoscope! It may also determine whether the owner will bring the cat back in for its next routine health check or whether they choose to avoid the practice at all costs – at least until their cat is seriously ill.
Examination tips
FAB’s Cat Friendly Practice campaign has generated a wide range of invaluable practical advice for reducing anxiety and stress in cats and making them more amenable patients – two books’ worth to date. These can be downloaded from
www.fabcats.org
Be flexible. The key is to find out what makes the cat more relaxed, and adapt the place/ position/way that you do the physical examination to suit the individual cat. Don’t rush. Never be in a rush when examining a cat. A little extra time does need to be allowed to keep the cat’s patience. This is a classic example of more haste less speed – the longer you can keep the cat’s patience, the more you will get out of a physical examination. Use gentle persuasion. Cats like to be in control; they don’t take kindly to being told where or how they are going to stand. Use gentle persuasion to trick the cat into thinking it is just on the table for some pleasant fuss and attention. Aim to complete the majority of the physical examination No amount of cat handling talent will transform a wideeyed hissing monster into a calm relaxed feline patient within the time constraints of a routine consultation! Clearly the way in which the cat is brought to the surgery, the type of carrier, the reception and waiting areas, and the routine in the consulting room all have an impact
without the cat realising you are doing anything more than just stroking it. Let the cat choose. Some cats will be happier being examined on their owner’s lap, others will be more relaxed on the floor. A window can provide a good distraction and some restless cats will more happily stay still on a window ledge than on the table. Others may prefer to stay sitting in their carrier for as long as possible. Very nervous cats may prefer to hide under a blanket for as much of the examination as possible. The preferred position. Some cats prefer to lie down, others prefer to stand. Try to carry out as much of the examination as possible with the cat in its preferred position. It will stay patient for much longer than if you try to force it into a position that you want it in. Apply minimal restraint. As soon as you try to hold a cat still, it anticipates something terrible is going to happen. Try not to restrain the cat more than simply placing a hand in front of it to stop it jumping off the table. Split the examination into short sections and in between allow the cat to change positions, have a look around, etc. As soon as the cat begins to get restless give it a break to relax – just a few seconds for a stroke or a walk around the table. Avoid direct visual contact. Perform as much of the examination as possible with the cat facing away from you, making sure to avoid direct visual contact. The cat will feel more secure if it is sat against you, facing away. Avoid loud or sudden noises and don’t face the cat into a bright light. Talk to it calmly and in a relatively quiet tone, moving slowly and avoiding sudden movements. Pain and anxiety. Be aware that older cats can suffer from osteoarthritis, making handling uncomfortable. The hypertensive or hyperthyroid cat may feel anxious and require a more cautious approach and minimal restraint. Last things last! Leave taking the cat’s temperature and opening its mouth to the end of the examination if these are likely to distress it.
A case for sedation?
14 WellCat
Some cats are so fearful that the above is simply not achievable even with the most patient of handling. These animals are the minority, thankfully, but if you encounter one try not to heighten its fear by scruffing and pinning it to the table; consider if chemical restraint is appropriate. If the cat does need to be sedated, ensure you get as much information as possible while it is sedated! This may include an oral examination, cystocentesis, blood sampling and imaging, if appropriate.
Physical examination
WellCat for life
Date: ................. Case number: ................... Owner’s name: ..................................................... Temperature: ..................
Pulse rate: ......................
Respiratory rate: ..............
3 Ideal weight
O
% change: ...............
4 Overweight
O
5 Obese
O
O
Quiet but alert
Lethargic
O
Dull
O
Hyperactive
Other: ...................................................................................................................
O
O
Head tilt
Abnormal (eg, wounds, swelling, asymmetry) ...................
Rate/rhythm:
O
O
No
Murmur:
Conjunctiva and sclera:
O
O
Normal
O
Pale
Pulse:
Hyperaemic
O
Icteric
Kidneys:
6 EARS O Normal
Bladder:
O
Abnormal (smell, discharge, wax, mites): ...............................................
O
Otoscope examination required? 7 NOSE Normal
O
O
O
No
Yes: .................................................
Abnormal (swelling, asymmetry, discharge – one or both nostrils, purulent/
serous/haemorrhagic): ......................................................................................................
8 HYDRATION Skin tenting: O Normal
O
Mucous membranes:
Stomatitis: Tongue: Palate:
O O O O O O
O
O
Deciduous
O O O O O
Mild Mild Mild Normal Normal
O
Pharynx and tonsils:
Abnormal
O
Normal
Adult
Dry/tacky
% Dehydrated: .........................
Abnormal eruption?
O O O
Moderate Moderate Moderate
O
Liver:
Abnormalities (cornea, iris, lens): ..................................................................................... . Retinal exam required? O No O Yes Findings: ...............................................
Gingivitis:
O
Normal
Bradycardia
O
Yes
Normal
O
⇒
Weak
15 ABDOMEN Compression: O Normal
Pupils normal size, symmetrical, normal pupillary light reflex
Tartar:
Increased resonance
Abnormal (wheezes, crackles, increased lung sounds)
14 CARDIOVASCULAR SYSTEM Heart rate: ..................
O Abnormal (displaced? any thrill?) O Tachycardia O Gallop O grade: .........../VI
O
Difference between L and R pulses?
5 EYES O Fully open, bright, clear of discharge, swelling and redness
9 MOUTH Dentition:
Normal
O
Dullness
Dysrhythmia
Systolic/diastolic
Point of maximum intensity? L/R, base/apex
4 FACE Normal
O
O
O O
Normal
...........................................................................................................................................................
Heart apex beat:
3 ATTITUDE O Bright and alert
O
O
O O
Percussion: Auscultation:
1 BODYWEIGHT Current (kg): ................ Previous (and date): ....................... 2 BODY CONDITION SCORE O 1 Very thin O 2 Underweight
Cat’s name: ........................................... Clinician: ................................................
O
Yes
O
No
Severe
Intestines:
O
O O O O
Normal Normal Normal Normal
O O O O O
Yes
O
O
Deficits
No
Abnormal (mass, pain) Abnormal (enlarged, mass, firm/soft, irregular, pain) Abnormal (inc/dec size, irregular, unequal size, firm, pain) Abnormal (abnormal contents, mass, pain) Abnormal (loss of tone, very firm, distended, thickened, painful)
Other findings (eg, masses, pain): .............................................................................
..................................................................................................................................... 16 COAT AND SKIN (mark abnormalities on diagrams) Coat normal
O O O O
Abnormal (hair loss, flea dirt, dandruff): ........................ Skin normal Abnormal (nodules, swellings, lumps): .........................
17 MUSCULOSKELETAL SYSTEM O No concerns
O
dorsal ventral Other (weakness, stiffness, lameness): .........................................................................
Further assessment required?
Severe
Bounding
O
O
No
O
Yes: ...................................................
18 CENTRAL AND PERIPHERAL NERVOUS SYSTEMS No concerns O Other: ....................................................................................
O
Severe
Abnormal (ulcers, masses, foreign bodies wrapped around)
Further assessment required?
O
No
O
Yes: ...................................................
Abnormal (ulcers, masses, foreign bodies)
O
Normal
Abnormal (inflammation, foreign bodies, masses)
SUMMARY
(problems, differentials, treatment and monitoring)
...........................................................................................................................................................
10 MUCOUS MEMBRANES O Pink O Pale O Icteric Capillary refill time:
O
Normal
O
11 SUPERFICIAL LYMPH NODES Submandibular: O Not palpable Not palpable
Popliteal:
O O
12 NECK Palpable goitre:
O
No
Prescapular:
Not palpable
O
Yes
O
Congested
Abnormal: .......................................................
O O O
Palpable
⇒
O
Palpable Palpable
O O O
Unilateral
Enlarged Enlarged Enlarged
O
ADDITIONAL FINDINGS
Bilateral
Size and position: ........................................................................................................................ 13 RESPIRATORY TRACT Respiratory rate and effort, noise: Anterior rib spring:
O
Normal
O O
Normal
O
Abnormal .................................
Reduced
Additional physical examination forms can be downloaded from www.fabcats.org/wellcat/veterinary WellCat 15
Breed-related disorders furtherinfo
at www.fabcats.org FAB Owner Info and Breeder Information Sheets Polycystic kidney disease in cats Cardiomyopathy in cats Pyruvate kinase (PK) deficiency Feline parturition – when to wait and when to worry . . . Feline blood groups and neonatal blood group incompatibility Choosing a pedigree kitten Feline acne and stud tail Cat ’flu information for breeders Tritrichomonas foetus infection in cats A manual for breeders is also in the pipeline (due to be published late 2008)
AROUND 10 PER CENT of cats in the UK are pedigree cats – some practices only see pedigree cats that are kept as pets, others have breeder clients. There are now certain conditions that we know to be breed related and many that are thought to have an inherited component. These and other breeding-related issues can be a minefield for vets in practice.
Inherited disorders in cats – confirmed and suspected
FAB has just launched an online list of many breed-related defects in cats, which can be found at www.fabcats.org/breeders/inherited_disorders. The list – which has been divided into specific cat breeds and, from there, into different body systems – gives details of over 100 conditions that appear to have an inherited basis. The conditions are categorised into: Those where the genetics have been confirmed and/or a genetic test is available. Those where a breed predisposition is recognised and the condition is strongly suspected to be inherited. Those where a potential breed predisposition is recognised but it is not currently known if the
www.fabcats.org/breeders
affect many different breeds of cat, and includes conditions that appear to affect certain breeds more frequently than others (or at least certain breeding lines of certain breeds). However, some of the conditions in this section may be multifactorial in nature and may possibly result from breed-related management practices and not solely from genetics. References are included throughout. It is important to recognise that all lists of this type have a number of inherent limitations. Perhaps the most fundamental is the need to understand that the amount of information available for a particular breed is not a reflection of the overall health of that breed. Rather, it will depend to a great degree on the level of surveillance within the breed, and on the breed’s long term popularity or special factors such as a breed’s usage in medical research. For example, it would be wrong to contend that the Burmese breed is significantly less healthy than the Tonkinese (which has fewer disorders listed): it is simply that the Burmese is more numerous and has an active and vigilant breed club, while the Tonkinese is less numerous and less studied. In fact, much of our information would suggest that, in very general terms, the less popular a breed is, the smaller the available gene pool and the more likely it is (per cat) that there will be inherited disease. In addition, many (and potentially all) of the inherited diseases known in pedigree breeds may also be found in mixed-breed cats (albeit typically at a lower prevalence).
Screening schemes
FAB PKD Screening Scheme The FAB polycystic kidney disease (PKD) screening scheme for Persian cats and related breeds was established over five years ago, and was able to show that 30 to 40% of Persian cats in the UK, like those in most other countries, were affected by this autosomal dominant disease. The scheme initially used ultrasound scanning to look for cystic holes within the kidneys. Once the gene had been identified, it incorporated buccal mucosal mouth swabs for gene testing. By facilitating the breeding of non-affected cats, the prevalence of PKD appears to be falling in Persian cats in the UK (FAB data).
advice to owners Veterinarians should counsel prospective owners to check with breeders as to whether their breed of cat has a history of any heritable conditions, and to request information about possible clinical and/or DNA based testing schemes. 16 WellCat
condition is inherited or not, or where there are only single case reports or evidence is anecdotal. Indications are given on the frequency of occurrence within the particular breed, and whether geographical differences are known to apply. The breed-specific section is followed by a more general section that addresses conditions that can
FAB/VCS HCM Screening Scheme FAB collaborates with the Veterinary Cardiovascular Society (VCS) to run a hypertrophic cardiomyopathy (HCM) screening scheme for Maine Coon cats and other breeds. This uses echocardiography to look for evidence of thickening of the heart walls and/or buccal mucosal mouth swabs to test for one of the autosomal dominant genes known to be involved in about a third of the cases in this breed. Unfortunately, the scheme is limited because the gene test detects only one of many different genes that may be involved in the development of HCM and echocardiographic changes of HCM do not always occur until later in a cat’s life.
Obesity and weight management OBESITY IS AN increasing problem in cats and has implications for longevity. Some studies suggest that obesity – defined as applying to pets that are 20 per cent above their optimal bodyweight – could now be affecting up to 40 per cent of the cat population. The rise in obesity in cats is linked to factors such as inactivity and changes in lifestyle. Indoor cats are known for their inactivity and neutering will also have an effect. Post-neutering energy expenditure reduces by 30% on average. In female cats the metabolic rate immediately slows after spaying, so if the same food is consumed in the same quantities, weight gain will result. Male cats, on the other hand, will experience an increase in appetite, resulting in food intake increasing by up to 25%, which is also combined with a gradual slowing of metabolic rate. Dietary manipulation is still the most common approach to weight management. The more traditional approach with a high fibre diet helps to regulate food intake through gastric distension methods with calorie dilution. A more novel approach involves the use of a high protein, low carbohydrate diet to trigger a metabolic switch in burning fat, while achieving satiety through altered hormonal signalling. Both dietary approaches also include the use of L-carnitine, as it has recently been found that high levels of L-carnitine and lysine decrease fat accumulation and help to preserve lean muscle mass. L-carnitine stimulates the conversion of fat into energy (less fat is stored in adipose tissue) and more fat is used as a source of energy. This has a sparing effect on protein: less protein is used for the production of energy and more can be made available to build muscle mass.
Weight loss programmes – some tips
Obesity clinics. Encourage your nurses to run clinics for obese cats and be extra vigilant in monitoring for conditions that may be related to obesity (eg, diabetes mellitus and possibly hypertension). Feeding diary. Most owners underestimate how much their cat is fed. It is useful to ask all the members of the household to keep a feeding diary for a week, to assess more accurately how much food the cat is getting. They need to include all treats, liquids (eg, milk) and whether the cat catches and eats prey. Information should be obtained as to how the owners measure the food, how it is fed (ie, ad libitum or set meals), if the cat is on any medication and if so how that is given (extra treats?), and whether the cat has access to another pet’s food. Only then can you accurately determine how many calories the cat may be receiving and calculate its requirement for weight loss. Goals. Ensure realistic weight goals and time frames, and make certain the cat is eating the diet you prescribe (see page 28). Be aware of the risk of hepatic lipidosis if weight loss occurs too rapidly. Activity levels. Increasing exercise, by even a small amount, through play or by placing food in different areas of the house, will help considerably.
scope for more Research commissioned by Hill’s Pet Nutrition identified that, in about 40 per cent of cases, vets failed to discuss a pet’s excess weight with an owner because they had observed that the client was also overweight. Over half of all pet owners questioned found that it was up to them to initiate the conversation about their pet’s weight with the vet, suggesting that there is still huge scope to tackle this issue more proactively.
furtherinfo
at www.fabcats.org FAB Owner Info Sheet The overweight cat
weights and measures Body condition score
1 VERY THIN Ribs highly prominent and easily felt with no fat cover
2 UNDERWEIGHT Bones are raised with minimal tissue between the skin and bone
3 IDEAL WEIGHT Ribs are easily felt
4 OVERWEIGHT Ribs are difficult to feel through moderate fat cover, and there may be a slightly sagging abdominal fat pad
5 OBESE Ribs are difficult to feel through thick fat cover, and there is a prominent sagging abdominal fat pad
The WellCatlog suggests to owners that they record their cat’s bodyweight and body condition score at each routine health check. It is important to monitor for any trends in weight and body condition score, and to calculate the percentage difference in bodyweight between assessments. It is easy to think of a 0·5 kg change in weight as being of little significance – but for a 3·5 kg cat, 0·5 kg equates to 15% of the cat’s bodyweight, which is certainly significant! Cats can also gain or maintain overall weight while losing body condition, hence it is essential to record body condition score in addition to weight. Accurate weighing is essential for accurate drug dosing, and for monitoring for changes in weight. A cat’s weight should never be guessed or assumed. Different breeds vary dramatically in size: the weight of normal adult cats may range at least from 3 to 6 kg. WellCat 17
Preventing behaviour problems stress-related disorders Cats under stress may develop abnormal coping behaviours or displacement behaviours, such as overgrooming, pica, hyperphagia and polydipsia. Some cats will experience hyperaesthesia, where the skin ripples due to heightened activity of the sensory nerves in the skin. Other disorders related to stress include idiopathic cystitis, inappropriate urination/ defecation, scratching as marking, and spraying.
BEHAVIOUR-RELATED PROBLEMS are being much more commonly recognised in general practice. This is likely to stem from better understanding of feline behaviour and improved recognition of behavioural problems, a rise in the number of cats kept purely indoors, increasing numbers of multicat households, and the presence of much more densely cat-populated areas as cats’ popularity as pets continues ever upwards. Historically, behavioural assessment has not formed part of routine preventive healthcare. However, as ever, prevention is better than cure and so it is important for the general practitioner to try to recognise factors in a cat’s lifestyle and environment that could increase the risks of behavioural problems, and to be able to step in with appropriate advice for owners that may help to prevent problems developing. The behavioural checklist on page 12 will help to pick up early indicators/risk factors that could lead to problems. Vets also have an important proactive role to play in preventive behavioural medicine.
Preventive behavioural medicine
1. Ensure that owners are providing for their cats’ environmental needs It is well worth going through the environmental checklist below with clients at routine health checks. This is something that a nurse or member of support staff could usefully do and will help to flag up potential problems before they become an issue. 2. Educate owners in recognising conflict between cats Conflict with other cats in the household or neighbourhood frequently leads to behavioural problems, but is underrecognised by owners. Signs of conflict between cats can be open or silent. Open conflict is easy to recognise – the cats may stalk each other, hiss and raise their hair, for example. However, silent conflict can be so subtle that it is easily missed. The cat creating the conflict (the assertive cat) can be identified as the one that never backs away from other cats, blocks other cats’ access to resources and stares at other cats. This cat may only have to approach or stare at a threatened cat for it to leave a resource, such as food
Environmental checklist Litter trays For cats that are not able to go outdoors to a suitable toileting area, are litter trays provided in quiet, secluded areas, away from the cat’s food and with easy access and an escape route? Other cats should not be able to sneak up on a cat in a litter tray Are litter trays located on each floor of the house? Is there at least one litter tray per cat plus one, all in different places? Have individual cats’ litter preferences been considered and are frequent changes of litter type avoided? Is dirty litter/faeces removed as soon as possible? Have litter tray size and whether the tray is open or covered been considered? These are important factors for some cats Access outdoors Is there more than one access point in multicat households? Cats will sometimes block other cats’ exit/entry points As far as possible, has it been ensured that cat flaps do not exit onto an exposed area where the cat may be ambushed or worried about going out? If the location is inflexible then consideration should be given to providing coverage with objects such as plants or boxes Can other cats enter through the cat flap? This can be source of anxiety. Magnetic collars can be considered but are not problemfree. Magnetic tags are easily lost, resulting in the cat being locked out. Also the flap takes a few seconds to open, so if a cat is being chased it may run headfirst into it. Other cats may be able to force their way through the cat flap and then become trapped inside the cat’s house. As an alternative, it is worth considering cat flaps that electronically recognise microchips (www.petporte.com)
activities, such as stalking and pouncing may be simulated by hiding small amounts of food around the house or by putting dry food in a container that the cat has to extract individual pieces from or move about to dispense the food Water Does the cat have a preference for running/ dripping water? Does it prefer glass/ metal/ceramic bowls of a certain shape/size? Does it have a preference for tap water, rain water, puddle water or bottled water?
Other considerations Access to owner. Does the cat actively seek human contact, or does it like to be able to get away from humans? Bed/core area. Does the area where the cat chooses to spend most of its sleeping time provide some privacy and also have an escape route? Are other animals able to sneak up on the cat while it rests? Passing places. For multicat households, does the cat have a way of getting past another cat that may be blocking a corridor/ stairway, etc? Scratching surfaces. Is the cat provided with horizontal and vertical scratching surfaces? The latter will need to be at least the height of the cat at full stretch Hiding places. Is the cat able to hide/get up high if needs be? It is Food important that the cat feels safe in its chosen spot, and is not Does each cat have its own food and water bowl in a convenient removed from it or annoyed while hiding there location that provides some privacy while eating or drinking, and an Interaction and play. Does the cat prefer to be petted and groomed escape route? or does it prefer play interactions? Some cats enjoy playing with Are bowls located such that another animal cannot sneak up on the toys, particularly those that mimic prey. Many cats also prefer cat while it is eating? novelty, so a variety of toys should be provided and rotated or Have cats’ natural feeding behaviours been considered? Predatory replaced regularly to maintain interest
Extra consideration needs to be given to environmental enrichment and stimulation for indoor-only cats 18 WellCat
Routine preventive care FAB has worked with its feline behaviour panel to put together a beautiful book called ‘Essential Cattitude – an insight into the feline world’, which will help readers to ‘think cat’ and consider things from the feline point of view. It is available for purchase, or can be downloaded for free, from www.fabcats.org
ANIMALS REQUIRE CARE tailored to their individual needs, and this is just as relevant for preventive care protocols as for any other treatment. A discriminatory approach to vaccination and antiparasitic treatments is important, weighing up the risks and benefits of treatment against the lifestyle of the cat, and disease and, where relevant, any zoonotic implications.
Vaccinations
Despite the success of vaccination, all the diseases that are vaccinated against are still present in cat populations, and thus a failure to maintain routine vaccination will place cats at increased risk of contracting disease. Currently approximately one-third of the pet cat population in the UK is regularly vaccinated, and it is likely that much wider use of vaccination would be of benefit, both to individual cats and to the feline population at large, in further reducing the prevalence and severity of disease.
E S S E N T I A L C AT T I T U D E
an insight into the feline world or a litter tray. Threatened cats often spend increasing amounts of time away from the family, staying in areas of the house that others do not use. The most common cause of conflict between indoor-housed cats is competition for resources such as space, food, water, litter trays, perches, safe places or attention from people. 3. Talk to breeders about genetics Genetics have an influence on behaviour. Encourage breeders not to breed from fearful animals or those with known behavioural problems. 4. Talk to breeders about socialisation Cats’ behaviour is largely influenced by learning and they make particularly strong associations in their early weeks of life during the socialisation period. Between 2 and 7 weeks of age strong connections are made in the brain between what is going on in the environment and how the cat feels about it. Therefore, all of the sights, sounds and experiences that the cat learns about will help develop a template of ‘normal’ life. The fear response in kittens starts to develop at around 6 weeks of age. 5. Follow Cat Friendly Practice principles If vets and nurses treat cats gently and calmly during consultations and hospitalisation it will help prevent them forming negative associations and so make them easier patients in the future. Experience from FAB’s Cat Friendly Practice campaign suggests this also helps to bond clients to the practice and to increase owner take-up of preventive healthcare.
Despite the importance of vaccination, adverse reactions to vaccines do occur, and that is a cause for some concern. All suspected adverse reactions should be reported to the Veterinary Medicines Directorate, www.vmd.gov.uk. Most adverse reactions are mild, but severe adverse reactions such as injection site sarcomas are possible. In the USA, vaccine-site sarcomas have been recognised for a number of years and are thought to occur at a rate of approximately 1 per 10,000 doses of vaccine administered. Studies on injection site sarcomas in the UK are currently underway. Still, serious adverse reactions are extremely rare and the benefits of vaccination far outweigh the risks involved. However, as vaccination inevitably carries some risk of side effects the use of discriminatory vaccine policies is advocated – whereby the risks and benefits of vaccination are carefully evaluated and discussed for the individual cat when determining with its owner the type and frequency of vaccination that is most appropriate, rather than necessarily vaccinating all cats against all diseases where a vaccine is available.
furtherinfo
at www.fabcats.org FAB Owner Info Sheets Spraying and soiling indoors Moving house with cats Introducing your cat to other cats and dogs Scratching or clawing in the house
When considering vaccination protocols, the lifestyle of the cat and risk factors for each disease need to be considered. The lifestyle and environment in which some cats are kept means they may not be at risk of exposure to certain diseases. For example, a cat that is kept strictly indoors and is in a single cat household has no appreciable risk of exposure to Chlamydophila felis or FeLV infection. In the primary vaccination course, consideration should be given to an additional vaccination at 16 to 20 weeks of age, since many kittens may still have maternally derived antibodies at 12 weeks of age, and this can be a cause of vaccine failure WellCat 19
Routine preventive care
Advice on choosing a well constructed and managed cattery will help clients avoid high-risk infectious situations. Send clients to
www.fabcats.org
to choose from almost 200 FAB Listed Catteries.
‘Core’ versus ‘non-core’ vaccines The American Association of Feline Practitioners has recently suggested considering feline vaccines as either ‘core’ or ‘non-core’. Core vaccines would be those for which routine use can be justified in all cats based on the prevalence of infection, the possibility of indirect transmission and the severity of disease. Non-core vaccines would be vaccines that are potentially very valuable in certain situations where cats are at genuine risk of exposure to the organism, but which it is difficult to justify using in all cats (eg, Bordetella vaccination).
To assist vets in suggesting rational control measures, the ESCCAP identifies risk factors for the principal internal worms and protozoa of cats. It categorises these according to cat type (kitten, lactating stray), health status (fleas/lice), environment (cattery, outdoors), nutrition (in particular, access to rodents, amphibians, reptiles, molluscs and raw meat/viscera) and travel. These, together with information on life cycle, characteristics, geographical distribution, clinical signs and diagnosis, are available at
Levels of protection Clients should be informed of the level of protection given by vaccines. Vaccination against feline parvovirus, for example, confers a high level of protection against infection and subsequent disease. Conversely, vaccination against feline calicivirus (FCV), feline herpesvirus (FHV-1) and Chlamydophila, although having a major role in protecting cats from disease and reducing the severity of disease in infected animals, does not necessarily prevent infection with these viruses; vaccinated cats can also become carriers of the viruses and pass them on to others.
In the clients’ WellCatlog we suggest, as a broad approach, that kittens are frequently treated against roundworms from about 6 to 16 weeks of age, and that adult cats are treated regularly against roundworms and tapeworms – every 2 to 3 months for outdoor cats that hunt, possibly extending to 6 months for an indoor cat. For the average cat, worming at 3-monthly intervals is recommended, together with strict flea control.
www.esccap.org
Flea treatments
There is no doubt that committing the practice to making a real effort to advise pet owners to manage flea control properly will have a positive impact on both the health of pets and the financial dynamics of the practice. Yet, despite their best intentions, many practices simply don’t get around to giving pet owners advice on flea control in any routine fashion.
Booster intervals Recently the necessity for annual booster vaccinations has been questioned, and some suggestions made that the frequency of vaccination for feline parvovirus (FPV), FCV and FHV-1 should be reduced to every 3 years. However, at present, there is insufficient data available to determine optimum booster intervals in adult cats, and any decision regarding reducing booster frequencies should be made after discussion and with informed consent of the owner. Vaccination of adult cats should nonetheless be assessed at least once yearly and, if A review of 286 cases of poisonings notified to the necessary, modified on the basis of Veterinary Poisons Information an assessment of their risk.
permethrin toxicity
Worming treatments
furtherinfo
at www.fabcats.org FAB Owner Info Sheets Tackling fleas on cats Worming your cat Vaccinating your cat Feline immunodeficiency virus (FIV) Feline infectious peritonitis (FIP) Feline leukaemia virus (FeLV) Feline upper respiratory tract disease – cat flu Chronic nasal discharge in the cat 20 WellCat
Service where canine spot-on permethrin preparations had been used on cats reported that 88% of the cats suffered neurological signs, and 10·5% died or were euthanased. Startling as these data appear, the VPIS considers that they probably underrepresent the scale of the problem. The paper, published in the Journal of Feline Medicine and Surgery in 2007, can be accessed at
Some cats are more likely to have parasite infections than others but, according to the ESCCAP (European Scientific Counsel Companion Animal Parasitology), an independent advisory board recently set up to promote a consistent approach to parasite control in pets in Europe, the difference is rarely absolute. Hence the need to provide all cats with appropriate worm control throughout www.fabcats.org/esfm/ their lives. Also, as it is difficult to permethrin.pdf control where outdoor cats defecate, particular attention needs to be For advice on managing given to worm control in cats permethrin poisoning cases see to minimise the infection pressure www.fabvets.org to humans (zoonoses) and other /info_sheets/permethrin.html animals.
During this process avoid merely referring to ‘spot-ons’. Cat owners buying ‘spot-on’ products in their supermarket may very well not get the efficacy that you may feel is embodied in that term, nor understand why. Furthermore, they will not be advised to avoid using dog products on cats or to keep cats away from treated dogs for some time if the dog preparation contains permethrin. Most cat owners do perceive veterinary advice to be useful and informative. Given the opportunity to understand the facts, most view the vet as the best source of effective flea treatment – for their home as well as for their cat. Using initiatives such as National Flea Week (www.nationalfleaweek.com) as marketing tools can help the practice to highlight flea control. Encourage owners to find out more about the different flea products available and how they work by going to www.fabcats.org/
owners/fleas
Blood pressure
HYPERTENSION IS COMMONLY recognised in older cats. There are likely to be several reasons for this including a heightened awareness of hypertension as a feline problem, better access to diagnostic facilities and, possibly, an increased prevalence of the condition related to the increasing age profile of the cat population. Blood pressure should be routinely monitored in older cats (see WellCat Health Chart, pages 6 and 7), as well as in any cat presenting with a condition or clinical signs that may be associated with hypertension, such as renal disease, hyperthyroidism, heart disease, neurological signs, blindness, hyphaema and suspected hyperaldosteronism (these cats may also have hypokalaemic polymyopathy). Although hypertension must be considered in these categories of patients, it is also very important not to misdiagnose hypertension and intervene inappropriately. Cats are particularly prone to increases in blood pressure associated with stress, which means that blood pressure measurements can be difficult to interpret.
Measuring blood pressure
It is vital to ensure the patient is as least stressed as possible at the time of measurement. Choose a quiet room, away from barking dogs and telephones, and ideally allow the cat a minimum of 10 minutes to acclimatise to the surroundings before measurements are taken. Then restrain the cat as gently as possible for the procedure – usually all that is required is steadying of the cat while the cuff is placed and readings are taken. For some cats, having the owner present limits the effects of stress on blood pressure readings. Further advice on acclimatisation times, location, noise and handling can be found in the Cat Friendly Practice booklets (see page 14).
on separate days to ensure that the elevated SBP is a persistent finding before commencing antihypertensive therapy in these cats. Signs of hypertensive retinopathy should also be looked for to provide further evidence of true hypertension. If any ocular signs consistent with hypertension are identified, the hypertension should be considered significant and treatment commenced immediately. SBP between 180 and 200 mmHg Not all hypertensive cats will have a SBP that is persistently above 200 mmHg, and therefore there is an overlap between the ‘normal range’ of blood pressures in healthy cats and those found in hypertensive cats. In general, cats with SBP readings between 180 and 200 mmHg should be regarded as potentially hypertensive patients. If there is evidence of hypertensive disease (especially ocular signs), or if the cat is known to have chronic renal failure or any other condition associated with hypertension, then antihypertensive therapy is justified. In the absence of these findings it can be difficult to establish whether the cat is normal and presumably stressed, thus having a higher SBP, or truly hypertensive. In some cats an acclimatisation period (see earlier) is helpful in order to rule out anxiety-related sympathetic stimulation as a potential cause of raised blood pressure. If the result is unchanged thereafter, the cat should be monitored closely, both for changes in SBP and also for the development of early clinical signs of hypertensive disease that would subsequently warrant therapy. SBP less than 180 mmHg Most normal cats have SBP readings of between 130 and 180 mmHg. In those cats known to have a condition predisposing them to hypertension, it is useful to monitor trends in SBP readings: if it is clear that the SBP is rising then therapy is warranted once it exceeds 170 mmHg. Therefore, for example, in cats with renal disease and hyperthyroidism it is prudent to maintain SBP below 170 mmHg.
furtherinfo
at www.fabvets.org FAB Clinical Protocol Blood pressure measurement in conscious cats FAB Veterinary Factsheet Choosing and using a blood pressure monitor, treatment and monitoring of hypertension
furtherinfo
at www.fabcats.org FAB Owner Info Sheet High blood pressure (hypertension) in cats
Ophthalmic examination can be a useful diagnostic aid. In early cases of hypertension, subtle changes such as the development of focal areas of perivascular retinal oedema may be seen. More dramatic changes would include serous or haemorrhagic retinal detachment and intraocular haemorrhage. Abnormalities are usually detected in both eyes although may be more severe in one. In many cases, the cat is only presented once severe disease is present and may be blind already. Over a long period of time, retinal degeneration may develop and can be recognised as areas of hyperreflectivity
Interpreting blood pressure
SBP greater than 200 mmHg In a typical ward or consulting room situation, 200 mmHg should be taken as the absolute upper limit of normal using the Doppler technique. Therefore, in general, cats with a systolic blood pressure (SBP) reading in excess of 200 mmHg can be regarded as being hypertensive and therapy is justified. However, some healthy cats may transiently have a SBP marginally above 200 mmHg. It is therefore prudent to recheck SBP in a cat with a pressure slightly above 200 mmHg where no signs of hypertensive disease are present. Ideally, measurements should be performed several times
WellCat 21
Feline dentistry
A low priority In a study of over 15,000 cats and 30,000 dogs examined at veterinary practices in the USA (JAVMA vol 214, pp1336-1341), the most common findings by far were dental calculus (affecting 24·2% of cats) and gingivitis (13·1% of cats). Despite these findings, fewer than 4% of animals with oral disease arrive with an owner history of the problem. In this particular study, none of the reasons given by over 47,000 owners for requesting a veterinary examination indicated any concern with the mouth.
VETERINARY SURGEONS AND NURSES will be well aware of how common dental disease is in cats. Clearly, therefore, this is an area where preventive care and early management can have an important impact on cat health and quality of life. Client education is fundamental to this – particularly as the cat’s ability to disguise pain means that cats rarely show overt signs of oral pain. The owners’ WellCatlog helps to explain the problems to owners and why it is so important to have regular dental check-ups and act on any veterinary advice for dental care early in the course of disease. Cats’ mouths are not the easiest area to examine in a consultation but as it is more common to find pathology than health in the mouth, a thorough oral examination is a vital part of every physical examination. Tips on performing a thorough oral examination are given below. Bear in mind that the cat with dental disease will be painful and this can hinder examination. Cat Friendly Practice principles will apply (see page 14). It is important to be aware also that dental radiographs are especially important in cat dentistry (see www.fabvets.org).
Oral examination
Examination under anaesthesia
Once dental disease is identified a full examination under general anaesthesia is required. Completion of a dental chart (see opposite) is an essential part of this process in order to record the presence of health and/or disease in a form that can be used now and later.
Why chart?
It is important to know which teeth and what pathology is present before treatment is started. ‘Missing teeth’ may be highly significant; the roots may be retained or the tooth may have undergone resorption. Occasionally teeth can be missing congenitally or may be impacted and/or embedded following a failed eruption. The success of treatment is impossible to gauge over time without the proper information gathered before initial therapy. Clinically it is a good habit to develop as it requires every tooth to be examined at every dental procedure. Therefore, problems are not likely to be overlooked. Charts can be used to help clients understand the need for them to play their part in maintaining the health of the oral cavity of their cat.
Common oral diseases
Start by gently lifting up the upper lip to examine the labial surface of the teeth on each side and to check oral mucous membrane colour and moistness, and capillary refill. The upper lip can be pushed up gently with the thumb in the commissure region to examine the upper molars fully With the cat sitting on the table, tip the nose dorsally by gently grasping from above with the thumb and forefinger over the respective zygomatic arches. The lower jaw will drop open slightly, just enough for you to slide the tip of your thumb or finger onto the lower incisors to gently depress the mandible. Alternatively the thumb and forefinger can be placed further rostrally, just caudal to the upper canines on each side; again the head is tilted back, as described above, so the lower jaw can be opened. This allows the tongue, palate and lingual surfaces of the teeth to be examined Some cats twist their head sideways when attempts are made to open their mouth, making a complete oral examination difficult. Others will use their claws to push your hands away. If the latter occurs, ask an assistant to gently hold the cat’s forelegs just above the elbow. This provides good control of the forelimbs and will help prevent you getting scratched The oral examination should be completed by pushing up at the base of the tongue in the intermandibular region while holding the head, as described above. This allows examination of the lingual frenulum and underside of the tongue, a common place for linear foreign bodies to lodge 22 WellCat
Periodontitis (gum disease). This is caused by the accumulation of plaque (a mixture of bacteria in a glycoprotein matrix) at the gum margin. Gingivitis occurs as a result of the bacterial impact and, if left untreated, will progress to periodontitis, inflammation and loss of the supporting structures of the tooth. Feline resorption lesions. The incidence of resorption lesions (‘neck lesions’) has been reported to be as high as 54% in cats with dental disease. The exact cause remains unknown but this appears to be a complex disease with several interacting causal factors. Two types of resorption lesions are seen – those where the lesion remains confined to the cemento-enamel junction, with no root resorption and ankylosis of the tooth root, and those where the resorption process involves the root, resulting in root resorption, ankylosis of the tooth root, and replacement of the resorbing root with bone. The two types are indistinguishable
FELINE DENTAL CHART DATE ANIMAL’S NAME
AGE
OWNER’S NAME
SEX
BREED
NUMBER
Buccal
R
Buccal Palatal
L
MAXILLA
109 108 107 106
104 103 102 101 201 202 203 204
206 207 208 209
CI GI Other
Buccal
R
L
MANDIBLE
Buccal Lingual
409 408 407
404 403 402 401 301 302 303 304
307 308 309
CI GI Other
Treatment
Recommendations
GI (Gingivitis Index) 0 = Normal: no inflammation 1 = Marginal gingivitis: red line/oedema 2 = Bleeds on gentle probing. Swollen 3 = Severe inflammation. Spontaneous bleeding
CI (Calculus Index) 0 = No calculus either side tooth 1 = Up to 25% cover bucally above/below gingiva 2 = From 25%-75% cover on buccal crown 3 = From 75%-100% cover on buccal crown
CODE KEY O Missing Tooth X Extracted Tooth P (mm) Periodontal Pocket FX Fractured Tooth
F GH GR RD
Furcation Exposure (F1, F2, F3) Gingival Hyperplasia Gingival Recession (Draw line to indicate exact buccal location) Persistent deciduous tooth (draw position)
FORL'S (FORL – state type and class eg FORL 2/4) Requires X-Ray Type 1: Focal resorption in crown/roots: Most of root/PL intact Type 2: Total resorption of roots & replacement by bone Class 1 = 0.5mm lesion in enamel Class 2 = penetration into dentine Class 3 = penetration into pulp Class 4 = major destruction of tooth Class 5 = crown lost/roots retained XR AT OM OD GVP
Produced by Pfizer Animal Health with the kind assistance of Norman W. Johnston
X-ray of tooth taken Attrition Oral mass Odontoplasty Gingivoplasty
BVM&S FAVD DipAVDC DipEVDC MRCVS AH229/04
Reprinted with permission, courtesy of Pfizer Limited
WellCat 23
clinically and intraoral radiographs are necessary to identify the lesion present and determine the appropriate treatment. Chronic gingivostomatitis. This is another complex disease, which is thought to be an aberrant immune response to plaque accumulation on the tooth. Cats with chronic gingivostomatitis are often difficult to treat and a thorough examination, routine blood tests, dental examination and radiographs are necessary to identify possible underlying causes and establish a treatment plan. Often multiple extractions are required to reduce the bacterial load in the mouth. Fractured teeth. If the pulp cavity is exposed, the tooth will require treatment. These teeth are painful (although very few animals show obvious dental pain), and an exposed pulp will result in inflammation and infection around the tooth root.
Tips for extracting cats’ teeth
furtherinfo
at www.fabvets.org FAB Veterinary Factsheet Dentistry FAB Clinical Protocol Managing the cat with chronic gingivostomatitis
Incisors, canines and the ‘first’ upper premolar are single-rooted teeth. The upper fourth premolar has 3 roots and all other teeth have 2 roots. Multirooted teeth must be sectioned into individual roots before extracting the tooth. The furcation (area between the two roots) lies below the main cusp, so sectioning must be performed from the furcation upwards to ensure correct division of the tooth. Pre-extraction radiographs are useful to identify abnormalities affecting the tooth roots or the extent of any pathology. Part of the crown should be removed to enable placement of the elevators in the correct position between the bone and tooth in the periodontal ligament space. Canine teeth should always be extracted surgically using a buccal flap approach.
dental tools The following specific instruments are required for feline dental extractions: Superslim elevator – the tip of the elevator is about 1·7 mm and enables good contact around the small cat roots Couplands no. 1 elevator, 3 mm tip – used to extract the canine teeth of cats Extraction forceps, pattern 76N – the narrow beaks (N) are well designed to allow good four-point contact on the smaller diameter roots. Extraction forceps are very useful for feline extractions as the tooth roots often have a bulbous end as a result of hypercementosis and require a gentle tug after the root has been loosened with elevators Small round friction grip burs, no. 1 or 2 – used to section teeth. The small bur allows an adequate groove to be created for placement of instruments without obliterating too much surrounding bone or tooth substance
An alternative choice of equipment is the EX5 – standard, EX5S – serrated for canine teeth, EX5H – modified with a notch for ankylosed teeth, and the Superslim 100C – for retained root tips (all available from www.drshipp.com) 24 WellCat
AS SHOWN IN the WellCat Health Chart on pages 6 and 7, the recommendation is that routine urinalysis is performed in cats aged 7 years and upwards, and that routine haematology and biochemistry are performed in cats from age 11 upwards.
Why this recommendation?
Not only will the initial tests provide individual baseline measurements that will be invaluable as a comparison should the cat later present for illness, but this also allows monitoring for trends in changes. It is important not to evaluate each set of results in isolation, but always to compare them with all previous results to look for parameters that may be within the normal range, but gradually increasing or decreasing. This will allow much earlier detection of important changes. Given
interpreting abnormalities Inevitably the more routine screening that is performed, the more abnormalities that will be detected where the significance is unknown. Skills need to be acquired for interpreting abnormalities and some important factors to take into consideration are outlined here.
In-house versus external laboratory
Although in-house analysers are useful for providing immediate results, they have a number of limitations and requirements that must be borne in mind: For many parameters, in-house analysers are not as accurate as external laboratories It is essential that quality control samples are run daily Consideration should be given to running some samples in parallel with an external laboratory In addition to improved accuracy and quality control offered by external laboratories, there is also assistance available with interpretation of results. This is key to deciding how to act upon those results Biochemistry Various in-house biochemical analysers are available and these vary in performance. In general, many are acceptable for evaluating urea, creatinine, total protein and liver enzymes, but are unreliable for electrolytes, albumin and globulin. In-house total thyroxine (T4) tests should also be interpreted with caution as they do not appear to be reliable. Haematology Again, different in-house haematology analysers are available, but in general they are reliable for determining packed cell volume (PCV)/haematocrit (HCT), red blood cell (RBC) count and haemoglobin, but are not reliable for providing information to determine whether an anaemia is regenerative or non-regenerative, the nature of a leukocytosis
Laboratory tests that cats are such ‘masters of disguise’ and often do not show overt clinical signs until in the advanced stages of illness, routine monitoring can make all the difference – picking up changes before signs of illness occur and allowing much more successful management of many disorders. The WellCatlog asks owners to tick a box to indicate when blood tests have been performed on their cat. With the owners’ permission, FAB may at a later date follow up this information with practices to aid understanding of feline life stage changes.
Urinalysis
Urinalysis is a very underused diagnostic test. Routine urinalysis in cats from 7 years of age upwards will help, in particular, to detect early diabetes mellitus and proteinuria; for both of these conditions, there are significant treatment advantages the earlier they are detected. The WellCatlog asks owners to record their cat’s urine specific gravity at each health check. Again, this basic information will allow trends to be analysed throughout the lifetime of cats.
or leukopenia, platelet count, and if there are any erythrocyte morphological abnormalities. A blood smear must always be examined to enable full and meaningful results to be interpreted. Blood smear examination by an experienced haematologist will significantly increase the information obtained; it will also help to identify errors in the analyser results, such as the presence of interfering factors (eg, haemolysis).
Influence of age
Young cats Haematology – younger animals are more likely to have a stress neutrophilia and a lymphocytosis. Biochemistry – alkaline phosphatase (ALP) may be increased due to bone growth. Total proteins tend to be low in growing animals; globulins may not reach ‘adult’ concentrations until 6 months of age. Calcium and phosphate are usually elevated during growth. Older cats In general as animals age cells becomes less able to tolerate any damage, which may predispose to dehydration and tissue anoxia. Immune system function decreases predisposing to infectious and neoplastic disease. Biochemistry – a reduction in functional renal mass occurs with age and older cats can be expected to have suboptimally concentrated urine ± mild elevations in urea ± creatinine. Creatinine can be normal if there is reduced muscle mass. Mild elevations in urea can also be caused by a recent meal or gastrointestinal bleeding. Samples should be taken following a minimum 8 hours’ fast, and should always be interpreted in conjunction with urinalysis.
Pre-anaesthetic blood tests
routine ‘profile’ Complete haematology – differential white blood cell count, red blood cell indices and evaluation of a blood smear including platelet numbers Biochemistry – urea, creatinine, glucose, total protein, albumin, globulin, alanine aminotranferase (ALT), alkaline phosphatase (ALP), sodium, potassium, chloride, calcium, phosphate Urinalysis – ‘dipstick’ for glucose, ketones and blood, sediment examination, pH, urine protein:creatinine ratio, specific gravity (by refractometer). Urine culture should be routinely performed in all diabetic patients, those with urine specific gravities below 1·030, where an inflammatory sediment is identified, and if urine protein:creatinine ratio is increased (>0·4) Additional tests – serum total T4 should be performed in senior and older cats, or those with compatible clinical signs and/or a palpable goitre
It is controversial whether pre-anaesthetic blood tests are warranted in clinically healthy patients with no abnormalities on physical examination. However, given the cat’s immense ability to disguise early signs of disease, these tests are undoubtedly useful and in a few apparently clinically well cats they will prove lifesaving – for example, the cat with subclinical renal disease. Furthermore, they again provide a baseline value. For example, in a cat that develops problems during anaesthesia or surgery, it can be difficult to interpret laboratory abnormalities without knowing if there were any pre-existing abnormalities. Clearly, however, these tests are only justifiable if any abnormal results are acted on, and management plans changed accordingly.
Influence of medications
Drugs may influence physiological changes or directly interfere with diagnostic tests, resulting in changes in laboratory parameters. For example: Corticosteroids may lead to elevated liver enzymes as a result of steroid hepatopathy; but bear in mind there is no steroid-induced isoenzyme of ALP in cats. A stress leukogram can also result Furosemide results in a reduction in sodium, potassium, chloride and calcium levels and an elevation in urea and total protein Oxyglobin leads to changes seen with haemolysis including increased creatinine, total protein and bilirubin, and reduced ALP. On haematology, oxyglobin will be measured together with total haemoglobin (this is a measure of the total oxygen-carrying capacity of blood, PCV/HCT will not reflect oxygen-carrying capacity) Methimazole can induce a leukopenia and/or thrombocytopenia Anaesthetic agents and sedatives may result in a reduction in PCV of up to around 20%. Total protein and white blood cell counts will also reduce. This is important to remember when a cat requires sedation for blood sampling
Influence of breed
While proof of specific breed-related laboratory abnormalities is lacking, there are some known or suspected breed anomalies: Birman cats often appear to have mildy elevated renal parameters that generally do not result in any clinically significant deterioration Abyssinian and Somali cats are often found to be mildly anaemic. This is likely to be the result of an inherited red blood cell osmotic fragility, and/or pyruvate kinase deficiency (www.fabcats.org/owners/pk_deficiency/info.html) See also page 16.
furtherinfo
at www.fabcats.org FAB Owner Info Sheet Pyruvate kinase (PK) deficiency
Hyperglycaemia – a stress response? Blood glucose should always be assessed using a glucometer if insufficient blood is obtained for an oxalate fluoride blood tube. Most human glucometers will underestimate blood glucose by approximately 1 to 1·5 mmol/litre. Recently a veterinary glucometer has become available (AlphaTRAK, Abbott) that is more accurate in animals and only requires 0·3 μl of blood. Stress hyperglycaemia is common in cats, although is |minimised by appropriate handling and examination (see page 14). When identified, however, hyperglycaemia must not simply be assumed to have been caused by stress and ignored, as early diabetes will be missed. Hyperglycaemia should therefore always be followed up by assessment for glucosuria on a home glucose sample and/or serum fructosamine measurement at an external laboratory. Be aware that if a blood sample is taken under α2-agonist sedation, this can also result in hyperglycaemia.
WellCat 25
Rational treatment protocols ANTIBIOTICS AND GLUCOCORTICOIDS are among the most widely used drugs in veterinary medicine. They are also among the most widely misused. With increasing concerns of multiresistant bacteria, appropriate antibiotics usage becomes even more vital. Equally, it is important to take into consideration a number of factors for each feline patient before corticosteroids are prescribed.
NSAIDs A protocol for the rational use of non-steroidal antiinflammatory drugs in cats is being developed by FAB, and will be available on
www.fabvets.org
26 WellCat
Antibiotics
Confine antibiotic use to appropriate clinical conditions. Before administering antibiotics always consider whether they are actually indicated. This means first obtaining a definitive diagnosis wherever possible, to identify conditions where antibiotic therapy is not appropriate. In many cases where antibiotics are administered, bacterial infection may not actually be present (eg, idiopathic cystitis). Where appropriate consider alternative therapies before initiating antibiotics. For example, many cases where antibiotics are initiated may respond just as well to supportive care alone, involving correction of any fluid and electrolyte imbalances and ensuring adequate nutrition. Consider the formulation most likely to result in completion of the prescribed course at the prescribed dose. With cats, antibiotic choice may be largely based on ease of administration, which clearly is a very important aspect to ensure compliance. Newer drugs, such as Convenia (Pfizer), which contains cefovecin, a 3rd generation cephalosporin, may significantly improve the ability to successfully administer long courses of antibiotics with no compliance problems. However, it is important not to base antibiotic choice soley on this, but also to consider the other vital aspects detailed below. Longacting cefovecin should be reserved for cats that definitely need at least 2 weeks of antibiotics, and those where a 3rd generation cephalosporin is indicated. Care must be taken not to use such a drug indiscriminantly for minor infections where a shorter course or a narrower spectrum antibiotic would be more appropriate. Inappropriate use of such antibiotics results in an increased risk of multiresistant bacteria and adverse drug reactions. Always try to choose an appropriate antibiotic based on bacterial culture and sensitivity results, and the location of the infection. If empirical antibiotics need to be used, the choice of drug should be based on the bacteria most likely to be involved in that location and their most likely sensitivity. In choosing an antibiotic, consideration also needs to be given to how well it will be able to penetrate the affected organ at an appropriate concentration. Use narrow spectrum antibiotics where possible as a first line treatment. Antibiotics that are required to treat relatively resistant bacteria in both human and veterinary medicine should be avoided for routine use where possible. Antibiotics such as fluoroquinolones and 2nd/3rd generation cephalosporins should be reserved for resistant organisms. Consider the duration of antibiotic treatment required. Treat for the shortest effective period possible in order to minimise therapeutic exposure to antimicrobials. Culture and sensitivity testing
at the conclusion of therapy will determine if additional therapy is necessary. Consider potential side effects. For example, retinal degeneration with enrofloxacin, neurotoxicity with metronidazole, oesophagitis with doxycycline and hypersensitivity reactions with cephalosporins. Ensure owners are adequately educated when antibiotics are prescribed. Clear written directions should be provided in addition to verbal instructions and a demonstration of how to administer the prescribed medication. Clients should be advised to complete the entire course of medication even if signs of illness have resolved. They should be warned of potential adverse reactions, and advised what to do if any such reactions occur. Do not depend on antibiotics for prophylaxis. Antibiotics should not be used as a prophylactic measure in place of good management and hygiene (eg, sterile surgical procedures). Where possible, address known risk factors for bacterial infections by treating underlying disease, or using appropriate hygiene precautions to prevent bacterial infection. Common risk factors for bacterial infections in cats include urinary catheterisation, presence of dilute urine, dental disease, diabetes mellitus, use of intravenous catheters, immunosuppressive drugs, and environmental factors such as poor hygiene, stress and poor housing.
Corticosteroids Duration of action Cortisone and hydrocortisone are short-acting preparations. Prednisolone and methylprednisone are intermediate acting. Dexamethasone and betamethasone are long acting. Only prednisolone and methylprednisone are appropriate for alternate-day therapy and
before starting steroids Complete all diagnostics wherever possible. Otherwise the treatment can mask signs of underlying disease and complicate the specific diagnosis and therapy. This is particularly important with lymphoma, since corticosteroid treatment may induce a multidrug resistance, meaning the neoplasm would be much less likely to respond to any subsequent chemotherapy. Decide on the reason for glucocorticoid therapy. This should be based on the definitive or presumptive diagnosis – ie, physiological replacement, anti-inflammatory or immunosuppressive activity. This allows an appropriate dose, regime and formulation to be chosen. Decide on the therapeutic end-point. This will enable
Well insured? generally are the only glucocorticoids that should be used for long-term administration. Duration of action is also greatly influenced by the formulation used: Sodium phosphate, hemisuccinate and sodium succinate esters are soluble, rapidly acting (minutes to hours) preparations. Acetate, diacetate, isonicotinate and tebutate esters are moderately insoluble, with a duration of days to a few weeks. Pivalate, diproprionate, hexacetate and acetonide esters are the least soluble, with a duration of a few to several weeks. Potency Understanding differences in glucocorticoid potencies is important. The anti-inflammatory activity of glucocorticoids is compared with hydrocortisone, which is assigned a value of 1. The longer-acting glucocorticoids generally have a greater relative anti-inflammatory potency; for example, the potency of prednisone is 4, while that of dexamethasone is 30. Route of administration For some diseases, consider whether an alternative route of administration would be preferable; for example, inhalational therapy for asthma and ophthalmic therapy for uveitis, rather than systemic therapy. Side effects There are many potential side effects associated with glucocorticoids including iatrogenic hyperadrenocorticism, diabetes mellitus, polyuria/ polydipsia, lethargy, hepatopathy, predisposition to gastrointestinal ulcers, muscle catabolism and atrophy, inhibition of bone growth, reduction in collagen synthesis (and thereby rate of wound healing), thinning of skin, capillary fragility (resulting in ease of bruising), alopecia, exacerbation of clinical or latent infectious diseases, and possibly predisposition to hypertension and exacerbation of pre-existing heart disease. Remember that locally applied (ophthalmic, topical, intralesional) glucocorticoids are also absorbed systemically and therefore are associated with similar systemic effects. efficacy to be assessed and help decide when the drug dose should be changed or an alternative treatment chosen. Consider the likely duration and tapering of treatment. Also, how the dose will be reduced. Consider possible side effects. In particular, if the cat is predisposed to any potential side effects such as diabetes mellitus. Select the most appropriate glucocorticoid preparation. It is important to be aware of duration of action and relative potency. Constantly re-evaluate the dose. The aim of rational corticosteroid use is to treat the condition effectively and prevent recurrence using the lowest possible dose. Aim for alternate-day therapy. With chronic conditions, alternate-day therapy dramatically reduces side effects on the hypothalamic–pituitary–adrenal axis.
EVERYONE UNDERSTANDS THE CONCEPT of insuring against unexpected expense but some people are bewildered by the huge array of products available to insure their pets. Hardly surprising – choosing from around 225 products can be daunting! However, the overall percentage of pet owners choosing to insure their pets is growing and, once it has been explained properly, most people do choose to insure their pets against the unexpected costs of veterinary fees and drugs resulting from treatment for illness or injury. As with all financial products and services, the sale of pet insurance is carefully regulated and many veterinary practices have chosen not to take on the commitment of selling policies. However, most veterinary practices believe strongly in the importance of pet insurance to their clients even though there still appears to be widespread confusion about the role of the practice in recommending the concept of pet insurance.
Practice recommendations
In short, there is no restriction on anyone in the practice recommending the benefits of pet insurance to a client – it is only when the practice makes specific recommendations, suggesting one brand before another, that training may be required.
A client’s first visit to the practice is the ideal time to ask the simple question ‘are you insured?’ Yes. From the business standpoint, those owners who do insure their pets are far more willing to consult their vets and will do so more frequently, thereby ensuring a regular income stream from insured clients and giving the practice the opportunity for earlier diagnosis, treatment and cure. Statistics show that insured customers are also more likely to undertake preventive care as they will be more aware of services offered and more likely to purchase food and other pet products from the practice. No. Uninsured owners are less likely to visit the vet. Petplan research shows that almost twice the number of insured clients visited the vet, over the previous 12 months, than those without insurance. Human nature will see people who are unsure of their finances hanging back to see whether or not a condition will worsen before visiting the vet, while insured clients will be confident in going to the vet assured that the best treatment will be available whenever they need it. If the client isn’t insured, a simple suggestion that it is in the animal’s best interest for the client to consider insuring against unexpected veterinary costs is all that is required to embed the concept and value of pet insurance as part of the practice’s customer offering. Working closely with practices, Petplan’s analysis of the market has shown that increasing the number of insured clients has a direct effect on the business bottom line and can play an important role in client retention. At a time when active client numbers continue to shrink, in most practices this invisible benefit can be of considerable importance. Source: Petplan – data on file
WellCat 27
Food and water intake Tips for increasing a cat’s water intake
THERE ARE TIMES when a client will need to increase their cat’s water intake or change its diet, for a variety of therapeutic reasons. The cat may have idiopathic cystitis and the aim is to encourage it to produce a more dilute urine, or it may have renal insufficiency and we want to help prevent dehydration. It may be that a prescription diet is needed. Whatever the case, clients may initially think that this is an impossible request and it is important for maximising compliance that they can be given some practical advice on how to achieve this.
coaxing the inappetent cat Cats can get themselves into a vicious circle of feeling ill, not eating and becoming depressed. They can respond well to some tender loving care and encouragement to eat from their owners. Finding things that are tempting and getting a cat started on eating again can make all the difference to its recovery. Suggest to owners that they: Try to keep the cat’s environment stress-free. For example, giving it somewhere quiet to relax away from other cats or dogs so that it does not have to compete for food or a resting place Increase the appeal of the food by adding strong flavours like fish Warm the food to body temperature to improve its aroma Gently smear a small amount of food on the cat’s paws or face – this usually stimulates a licking response that may then get the cat started on eating again Try particularly tasy foods such as cooked fish or chicken, or commercial supplementary foods. Alternatively you may prescribe the cat with a palatable, high calorie food (eg, Hill’s a/d) Avoid feeding human foods that contain onion or garlic, as these can cause toxic damage to cats’ red blood cells, with resultant anaemia. Examples include some baby foods, soups, flavoured meats and food flavourings
Some inappetent cats will respond well to hand feeding, particularly when they are feeling relaxed such as when they are in a favourite resting place, or are being stroked. However, owners should resist the temptation to keep pushing food in front of the cat’s nose if it isn’t interested as this can result in a food aversion 28 WellCat
Feed a wet food. Add water to the food. Offer ‘broths’ (eg, water that meat has been boiled in). Use flavoured ice cubes. These can be made by boiling meat and freezing the water from the meat in ice cube trays. An ice cube can be put in the water bowl each day to add a ‘meaty’ flavour to the water. Many cats prefer a specific type of water – rain water, puddle water, bottled water or tap water. Try different types to find the cat’s preference. Some cats prefer flowing water (eg, water fountains, a dripping tap) to still water. Many cats also have a preference for the type of container that the water is in (glass, metal or ceramic rather than plastic, which retains odours), as well as the shape of the container (large wide container, glass, mug, etc). It is useful to try different containers in different locations in the house to identify an individual cat’s preference. Multiple water bowls should be provided, located away from food and litter areas. Cats should be able to drink alone without the risk of another cat coming up behind them.
Tips for changing a cat’s diet
Changing a cat’s diet, whether from dry to wet food or onto a prescription diet, can be problematic. Before starting to change diets, it is important first to ensure that the cat is at home, feeling better and eating its usual diet normally. If the cat has food available all the time, and refuses the new diet, it may be easier to start by changing its feeding schedule to meal feeding by only leaving food out for 1 hour at each feeding time. Start to offer the new food in the cat’s usual feeding bowl next to the old diet, using another bowl for its old food. If the cat doesn’t eat the new diet after an hour, remove it until the next feeding. At the next feeding, repeat the process, always providing fresh new food. Once the cat is readily eating the new diet, gradually decrease the amount of the old diet offered (by about 25% each day) until the change is complete. Using this strategy, the change should be completed over a period of 1 to 2 weeks. If necessary, small quantities (less than a tablespoon per cup or can of food) of your pet’s favourite food, or meat or fish juices, can be mixed with the new food initially to make it more appealing. Feed your pet in a quiet environment where it won’t be distracted. Monitor the cat’s weight – no more than 10% bodyweight should be lost in the transition from one diet to another. Be aware of the risk of hepatic lipidosis if weight loss occurs too rapidly.
Euthanasia – best practice SADLY EUTHANASIA IS a very common and necessary procedure in day-to-day veterinary practice. It is sometimes easy to forget what a big responsibility it is and that, as far as the client is concerned, it constitutes the single most important and distressing time that they ever take their pet to the vet. While the purpose of euthanasia is to alleviate the cat’s suffering, it is vital to remain sensitive to the bond between owner and cat. Most owners will remember always every detail of their cat’s euthanasia and the vet who euthanased their cat. A good experience can bond the client to the practice for life; a bad experience can lead to much distress, complaints and, in some cases, clients moving practices. It is clearly extremely worthwhile to take the time and effort to make the experience as calm, compassionate and gentle as possible. The vet’s ability to communicate with the owner and help them through this difficult time is key.
Planning for euthanasia
When euthanasia is being planned in advance, encourage owners to discuss their expectations and talk through what will be done and how (see box). Consider when the euthanasia will be performed: if it is a scheduled appointment, try to arrange a time when you are less likely to be rushed and, if it is taking place at the practice, when it is less likely to be busy. If the owner wishes to take the cat’s body home, arrange a suitable ‘coffin’ or ask if they have a special blanket or basket that they would like the cat to be placed in. These various discussions could be handled by a well-trained veterinary nurse and need not necessarily involve the vet. It is certainly worth investing in sending one of the nurses on a pet bereaverement counselling
what to discuss Pros and cons of euthanasia at home versus in the clinic Whether the owner wants to be with their cat at the time of euthanasia If so, what their role will be. For example, will they want and be able to hold their cat, or would they rather a nurse held the cat while they stroked its head? What the procedure will involve (eg, prior sedation, catheterisation, what will be done if intravenous access cannot be obtained, etc) How the cat may react (eg, the possibility of agonal breathing, and urination/defecation following the procedure) Whether the owner will want to take the cat’s body home, or opt for normal or individual cremation If appropriate, whether they would like a post mortem examination. Discuss the benefits, including whether it may help gather valuable information that will benefit other cats in the future
course, such as the one run by The Blue Cross and the Society for Companion Animal Studies. A sympathetic and patient person can make the world of difference to the owners.
Performing euthanasia
Always handle the cat gently and calmly and try to make it feel as relaxed as possible. Consider placing an intravenous catheter in advance. This will allow the procedure to go much more smoothly without the risk or worry of perivascular injection, being unable to find the vein, or blowing the vein. In fractious or anxious cats consider premedication or sedation prior to this. A ketamine/midazolam combination can be really useful where heavy sedation is required but it should be avoided in oriental Don’t leave a cat suffering while waiting to be type breeds as it can have an euthanased (make it as comfortable and pain-free adverse effect, making them as possible right up to the point of euthanasia) hyperactive and uncontrollable Don’t be impatient and rushed rather than sedating them. Note Don’t be unsympathetic this can also occur unpredictably Don’t ignore the owner’s wishes in any breed of cat, including Don’t attempt intracardiac injection domestic shorthairs/longhairs. Don’t use sedatives that will reduce blood
Some don’ts
pressure to the extent that it can make finding a vein more difficult (eg, medetomidine) In cases where intravenous access is very difficult, consideration can be given to intrarenal, intrahepatic or intraperitoneal injection. If the owner is present always explain what you are doing and why.
Before performing the euthanasia allow time for the cat to relax where possible. Some owners like to spend some time alone with their cat; others, once the decision has been made, just want it carried out immediately. Offer the owner both of these options.
WellCat 29
If the owner wants to hold the cat while euthanasia is performed, then consider using an extension set attached to the catheter so that you can inject the cat from a distance. This often works very well, with the owner barely aware that you are doing anything as the cat appears to drift off to sleep in their arms. Give the owner a towel or incontinence sheet to hold the cat in and warn them that it may urinate and defecate during the procedure. Have a bed ready to lay the cat on following the euthanasia, a clean towel to cover the cat and incontinence sheets in case urination occurs. Be respectful of the body, and arrange the cat so it looks as peaceful as possible.
After the procedure
Some owners may want to leave straightaway. If possible, arrange for them to leave via a back door so they don’t have to exit through a busy waiting room. Some owners may want to stay and talk for a while. Others may want to be left alone with their cat’s body – ensure that you don’t rush them if that is the case. Send a sympathy card a couple of days later – clients usually really appreciate this gesture and it demonstrates that you have a genuine care for their cat.
Euthanasia in the owner’s absence
Sometimes it may be necessary to euthanase a cat in the owner’s absence – perhaps because the owner is away, is unable to get to the practice in time if their cat has deteriorated while hospitalised, or has chosen not to be there at the time. It is comforting to owners if they aren’t present to know that their cat was as comfortable and happy as possible when euthanasia occurred.
Sleeping cat
Pet Bereavement Support Service
Anyone who has experienced the loss of a much-loved pet will understand how devastating it can be. Sometimes it can be really helpful to talk to someone who understands. The Pet Bereavement Support Service (PBSS), run by The Blue Cross and the Society for Companion Animal Studies (SCAS), offers telephone and e-mail support for anyone who is experiencing the loss of a pet, whether through death, ill health, rehoming, enforced separation or an accident. The service, which has supported thousands of bereaved pet owners since its inception in 1994, also offers practical information, support and training on pet bereavement for veterinary practices and others. Telephone: 0800 096 6606 (lines are open 8.30 am to 8.30 pm every day) e-mail:
[email protected] All calls and e-mails are free and confidential and are answered by trained volunteers throughout the UK.
FAB sympathy cards carrying the message
‘In memory of a special cat’ together with a brief explanation of the charity’s work, are available for purchase, price £10 per pack of 10 cards and envelopes (inclusive of p&p). The price includes a donation to FAB, so sending a card shows clients that you care and that something positive will result from the loss of their cat. 30 WellCat
Make sure the cat is as relaxed as possible and, where appropriate (depending on how sick the cat is), had some ‘enjoyment’ before the euthanasia (eg, a cuddle, feeding of treats, etc) that you are also able to relay to the client. Ensure that adequate analgesia for any painful conditions is given up until the point of euthanasia. If the owner has arranged to collect the cat’s body, arrange the cat carefully in its basket or a coffin box in clean sheets/towel with incontinence pads, before rigor mortis sets in.
50 years of helping cats Back in those early days the profession didn’t know what caused cat ’flu, and feline hyperthyroidism, immunodeficiency and leukaemia were unknown words. A cat did not even have the status of a small lap dog and small animal medicine (let alone feline medicine) was something for vets who couldn’t hack the real thing! Asking vets to consider minimising stress for cats coming into the practice would surely have been met with complete incredulity. How things have changed – now cats are a vital part of practice and FAB’s work to provide information on feline disease and treatment has come into its own. Through funding lectureships and residencies at the veterinary schools, forging links and working with other feline interest groups outside the veterinary profession, FAB has amassed a wealth of expertise across the broad spectrum of cat keeping. The charity now occupies a pivotal position in feline welfare, supporting and – perhaps more importantly – helping to bridge the divide between cat owners, carers and the veterinary profession. In 2006, FAB launched its Cat Friendly Practice campaign, which has been enthusiastically received by practices and has proved a great forerunner for this WellCat for life campaign. FAB’s division, the European Society of Feline Medicine, is now one of the profession’s largest veterinary groups. Its annual congress, held in different locations across Europe, has become a hugely popular event and the Journal of Feline Medicine and Surgery well established. Indeed, in 2009, ESFM will add an extra dimension to the journal with 6 extra issues. Called JFMS Clinical Practice, these will carry colour reviews on all aspects of feline practice and will be designed to be highly practical and applicable to day-to-day practice. Over 350 practices in the UK and many abroad are now FAB Practice Members and receive a range of benefits. If you want to keep up to date with things feline then there is no better way – see overleaf for more information.
This year the Feline Advisory Bureau celebrates 50 years of making cats’ lives better.
WellCat 31
Practice membership Practice membership of FAB and ESFM
£140 UK £160/€231 Overseas (prices for 2008 membership)
Members receive:
_ Bimonthly Journal of Feline Medicine and Surgery and, from 2009, bimonthly JFMS Clinical Practice _ Quarterly CatCare journal _ 10 x £20 educational vouchers redeemable for any practice member (veterinary surgeons and nurses) to attend FAB and ESFM education days and conferences _ Complete set of FAB information sheets including new and updated sheets as they are produced _ Certificate of membership for waiting room _ Cat Group policy statements and discussion documents, including new sheets as they are produced _ Listing on the FAB website (including optional link to the practice’s own website) _ Access to specialist information on the veterinary section of FAB’s website (www.fabvets.org) _ 10 free WellCatlog client booklets _ Free Cat Friendly Practice literature dispenser plus some leaflets
Additional Branch Practice
JFMS Clinical Practice – coming in 2009
£75 UK £120/€171 Overseas (prices for 2008 membership) Members receive: _ Certificate of membership for waiting room _ Listing on the FAB website (including optional link to your own website) _ 2 x £20 educational vouchers redeemable for any practice member (veterinary surgeons and nurses) to attend FAB and ESFM education days and conferences
Practice membership Application form Please complete in block capitals and post or fax to the FAB Office, Taeselbury, High Street, Tisbury, Wiltshire SP3 6LD, UK, fax 01747 871873 Title ...................... Surname ........................................................................................................... Forename(s) ...................................................................................................................................... Practice name .................................................................................................................................. Address ............................................................................................................................................ ........................................................................................................................................................... ..................................................................................... Postcode .................................................... Tel ........................................................ E-mail ................................................................................ Website address ………………………………………………………… FAB Practice Membership £140 UK £160/€231 Overseas (prices for 2008 membership) Additional Practice Branch Membership £75 UK £120/€171 Overseas (prices for 2008 membership – please enclose name, address and contact details with your application) HOW TO PAY By Cheque: please make cheques payable to ‘FAB Ltd’ By Debit/Credit Card: please complete the section below. We accept VISA/MASTERCARD/SWITCH/DELTA (delete as appropriate) Card number:
OOOOOOOOOOOOOOOOOOO Valid from: ............. 32 WellCat
Valid to: .............
Security code: .............
Issue number (Switch only): .............
WellCat for life SUPPORTED BY
The Governing Council of the Cat Fancy
Vicki Adams Sarah Caney Martha Cannon Julie Cory Charlotte Dye Yaiza Forcada Darren Foster (Australia) Pru Galloway (New Zealand) Tim Gruffydd-Jones Danièlle Gunn-Moore Andrea Harvey Angie Hibbert
Registered Charity no: 298348
Mark Jackson Michiel Kraijer (Netherlands) Amy Mackay (USA) Nicki Reed Suzanne Rudd Anita Schwartz Kerry Simpson Andy Sparkes Séverine Tasker Samantha Taylor Maud van de Stadt-Gould Sheila Wills
Jon Bowen Robert Falconer-Taylor Vicky Halls Sarah Heath Kim Horsford Jenna Kiddie Daniel Mills Peter Neville Francesca Riccomini Roger Tabor
