IS A TRADEMARK OF THE felineadvisorybureau

2008 © FAB

WellCat for life

In collaboration with www.hillspet.com www.petplan.co.uk www.merial.com

Printed by Blackmore Ltd, Shaftesbury, on environmentally friendly paperISBN 978-0-9558698-0-8

An initiative from the felineadvisorybureau

WellCat for life

A guide to engaging your cl ients in a l i felong partnership

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

A g u i d e t o e n g a g i n g y o u r c

1 Well overdue2 Well worth it?3 How does it work?5 Life stages redefined6 Routine health checks . . .

. . . and a partnership of care8 Life stage focus

12 History taking14 Physical examination16 Breed-related disorders17 Obesity and weight management

18 Preventing behaviour problems19 Routine preventive care21 Blood pressure22 Feline dentistry24 Laboratory tests26 Rational treatment protocols27 Well insured?28 Food and water intake29 Euthanasia – best practice31 50 years of helping cats32 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

WellCat 1

WellCat for lifewell overdue

c l i e n t s i n a l i f e l o n g p a r t n e r s h i p

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 beseen again unless they fall ill, and we all recognise – perhaps in ourselves – the well-meaning, butdistracted, 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 veterinarypractices. Some of the drivers for these behaviours can be found in ignorance of what is entailed inthe 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 catsunder 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 vetand 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 thecat’s health rather than just attending to its sickness. It aims to provide a clear platformfor 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 theright course and that, while some owners will do absolutely everything they areasked, others will do so reluctantly or, at best, sporadically. To address this, theWellCat 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 theeveryday 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 laboratorytests. It also provides some tips to pass on to your clients to

improve understanding and compliance when changing theircat’s diet or increasing its water intake, for example. Some

important considerations are highlighted regarding drugsthat 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 ofthe most commonly performed

and important procedures in general practice, euthanasia.

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. Thereare 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!

Each year, around 500,000 kittens are born, around90% of which are moggies. While the average lifespan of a cat is about 13 or 14 years, many willlive into their late teens and some beyond 20 years.Like the human population, the feline population isan ageing one, with almost half the cats in the UKaged 8 years+.

In contrast to dogs, around 60% of cats cost theirowners nothing to obtain, but this doesn’t diminishthe strength of feeling that so many people have fortheir cats. Indeed, 10% of people would ratherspend time with their cat than with anyone else

(intriguingly, this figure is higher still in Scotland!) and one-third of owners acquired their catexpressly for companionship.

Over the years, the veterinary profession and animal charities have done an excellent job ofencouraging neutering and, today, around 90% of cats in the UK are neutered. However, thereare probably more than 4 million cats that are currently unvaccinated and the rate of revaccination decreases with age. In asurvey of committed cat owners, 37%admitted that they had not visited the vetin the past 12 months and, inexorably, thesource of information about pet welfareissues has shifted from the vet – with55% seeking information from othersources. Most worryingly, 37% of ownerssaid they would consult other sources,rather than the vet, for information concerning their pet’s health.

Clearly, the cat represents a considerable opportunity to veterinarypractice. 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.

2 WellCat

‘There is greater readiness to take part in proactive and

preventive healthcare. Thisprobably stems from our own

changed approach – we, inturn, are more proactive in promoting it to the clients.’

WellCat for life well worth it?

‘Cats are much calmer –they chill out, settle andlife is much easier.’

‘We talk with much greater confidence,our understanding of cat needs isgreater, clients pick up on our greaterinterest and knowledge. We know thatour regular cat clients talk to theirfriends and recommend us as a practice that is good with cats.’

If WellCat for life succeeds in making life much easier, it’ll be well worth it!

WellCatlog. This is a complementaryowners’ booklet that can be personalisedwith the practice stamp on the back coverand given to clients with cats of any age. Itis just as suitable for those with new kittenscoming into the practice, as for those withold cats requiring close veterinary attention.In its 36 pages, it discusses the health andcare requirements of cats throughout theirlives. It asks owners to get involved in preventivehealthcare byexplaining what

you, as their vet, will be checking in their cat and encouraging themto record various health parameters. Owners are warned of diseaserisks associated with different life stages and advised of the all-too-often subtle signs to be vigilant for. Moreover, they are asked brieflyto log details of any episodes of sickness in their cats that aresevere enough to warrant a trip to the vet. FAB is asking owners tosend in their WellCatlog when their cat dies, and the expectation isthat, in time, an invaluable bank of data will be built up that will helpdirect further developments in feline veterinary care. With theowner’s permission, FAB may, at a later date, follow up informationrecorded in the WellCatlog with the relevant veterinary practice(s),as required.

CAT OWNERS TURN to a variety of sources for information on their cats’ health. Ideally this wouldalways 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 willadvise owners. Different points of contact assume different degrees of importance, depending on thecat’s age and perceived state of health, and so WellCat for life seeks to make contact with as manycat 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’sweight and age – and, from there, to think about its state of health. This opportunity for othercat 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 ownersto 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

WellCat 3

WellCat for life

The WellCatlog willalso be available fromselected catteries,breeders, rescueorganisations and petshops with the aim ofdriving owners to theveterinary practice

How does work?

An initiative from the felineadvisorybureau

WellCat for life

A guide to engaging your cl ients in a l i felong partnership

WellCat for life veterinary handbook. This comprehensive guideoutlines a gold standard of preventive care for cats and has beendeveloped by the FAB feline expert panel. It is the cornerstone of

the WellCat for life programme and has been designed to be usedalongside the accompanying, more consumer-oriented, materials.

WellCat logyourTo help keep your cat safe and healthy

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 muchabout their cat’s health, and available from pet shops and other outlets, theWellCat Wheel of Furtune introduces the concept of life stage and bodycondition in a light-hearted way. By rotating the wheel, owners can calculatehow 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 whomay 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, atwww.fabcats.org/wellcat/for_life, provide supplementary information and downloads to supportthe programme – and, in time, will carry updates and feedback.

WellCatclub. Also being launched as part of the WellCat for lifeprogramme 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 inputtheir cats’ health data directly online.

4 WellCat

furtherinfoFAB 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 vetsFAB 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. Theycan be downloaded for free by FAB practice members (seepage 32 for details of practice membership) or for a fee byother veterinary personnel

FAB Veterinary Factsheets. Information sheets for vets are being developed and will shortly be freely available atwww.fabvets.org

Cat Friendly Practice. Information for vets on creating acat 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-orientedclinical review articles on feline medical and surgical topics, aswell as ongoing information on WellCat for life

For clientsFAB Owner Info Sheets. Almost 500 pages of information

on feline disease, behaviour, care and management is freelyavailable to cat owners on FAB’s website, www.fabcats.org.This resource is being continually expanded and updated

FAB breeder information. Information aimed specifically atcat 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 bedownloaded from www.fabcats.org/catfriendlypractice/own-ers.html. Printed copies may also be purchased for distributionin 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

WellCat for lifeHow does work?

has made a great leap forward in keeping your cat safe and healthy

WellCat for lifeGo to www.fabcats.org or ask here for further details

WellCatclub

WellCat 5

Life stages redefinedEARLY ON IN THE PLANNING of WellCat for life,it became clear that the cat’s life stages were notwell defined. The terms senior and geriatric wereoften used interchangeably, the age at which a catwas considered to be senior or geriatric was notconsistent, and the threshold for ‘old age’ wascommonly quoted as being around 8 years old.

Clearly, however, cats often live well into their teens(some beyond), and many 8-year-old cats arehardly geriatric! The first step, therefore, in creatinga lifelong healthcare programme was to redefinefeline life stages into more meaningful and appropriate categories, taking into account how

cats mature both physically and behaviourally and the onset of common changes and diseaseproblems. 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.

To encourage owners to think about the age oftheir cat and what it means in terms of the risks ofcertain diseases, what they should look out for,and the preventive healthcare that should be discussed with their veterinary surgeon at each lifestage, the cat’s age is also expressed in terms ofthe human equivalent.

Age of cat

0 – 1 month2 – 3 months4 months6 months

7 months 12 months18 months2 years

3456

78910

11121314

15161718192021

Human equivalent

0 – 1 year2 – 4 years6 – 8 years10 years

12 years 15 years21 years24 years

28323640

44485256

60646872

768084889296100

Kittenbirth to 6 months

Junior7 months to 2 years

Prime3 years to 6 years

Mature7 years to 10 years

Senior11 years to 14 years

Geriatric15 years+

Life stage

Tigger 3 months old

George 13 years old

Chinarose 16 years old

Nemo 8 years old

Rosie 3 years old

Sugar 13 months old

Routine health checks . . . ONE OF THE PRINCIPAL aims of WellCat for lifeis to lay down a ‘gold standard’ for what routine monitoring checks are advisable, and when theseshould be performed throughout life. By educatingowners about the importance of preventive care, andof routine health checks in picking up early signs of disease, and by providing a standard for veterinarysurgeons 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 HealthChart, which recommends when it is advisable forhealthy cats to undergo routine physical examination,preventive healthcare, weighing and body conditionscoring, blood pressure measurement, urinalysis andhaematology/biochemistry. (Clearly the level of monitoring will need to be tailored in a sick cat.)

The WellCatlog also discusses what is involved in aroutine physical examination, health issues at differentlife stages and what further tests may be necessaryand why. The aim is to demystify the processes andmake things as stress-free as possible.

An important theme that runs throughout is the cat’sextraordinary ability to hide signs of illness – anysigns it does show are usually quite subtle. This isbecause in the wild the cat can be a prey animal aswell as a predator – if it shows signs of weakness itmay attract attention. And, unlike the dog, which isa pack animal, the solitary cat has nobody to rely onbut itself. The idea, generally, is that if owners canbe more involved with monitoring their cats’ health,more health issues will be detected earlier. To thisend, the WellCatlog discusses elements in a cat’shistory that owners should inform the vet of at anyhealth checks, and what changes in appearance,behaviour, mobility and demeanour they should lookout for.

Physical examination, bodyweight and body condition scoringThe 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 boostervaccinations. Thereafter, it is more likely that the health

Age 2-3 months 6 months 12 months 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 �/� Once or twice a year � Twice a year – Not usually necessary at this age

MaturePrimeJuniorKitten

6 WellCat

WellCat 7

. . . and a partnership of carestatus of a cat could change more quickly, and soonce or twice yearly checks are recommended forcats in the 11- to 14-year-old bracket, and biannualchecks for those 15 years and above.

Blood pressure measurement and urinalysisAnnual routine blood pressure monitoring and urinalysis is recommended when cats reach themature life stage (7 years of age upwards). Above8 or 9 years of age, the risk of hypertension startsto increase, and early detection is vital to preventcomplications of hypertension, such as hypertensive retinopathy and blindess. Startingblood pressure monitoring at 7 years of age allowssome baseline measurements to be obtainedbefore the cat reaches the more ‘at risk’ ages.

Similarly, commencing routine urinalysis whencats reach maturity, a few years before a declinein renal function might be expected, providessome individual baseline measurements to allowdetection of any changes and monitoring oftrends in the later years. It is also useful for

picking up diabetes mellitus as early as possiblein this ‘at risk’ age group.

Blood profilesPerforming ‘blood profiles’ as a routine when catsreach the senior life stage (from 11 years upwards),will help to detect early evidence of some diseasesas soon as possible.

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

GeriatricSeniorWellCat Health Chart

Kitten (0 to 6 months)Most cat owners will bring their kitten to the veterinarysurgery for first vaccinations and neutering, but oftenthey do not return until the cat becomes ill much laterin life. It is therefore important not to assume that, justbecause a kitten presents for its first vaccination, itsowners will continue to bring it in for annual healthchecks and boosters. Instead every opportunity needsto be taken in these first visits to bond the client to thepractice and educate them about the importance of alifelong preventive healthcare scheme.

A great deal of information needs to be imparted inthe first few visits (see ‘points to cover’ below) toequip the owner with what they need to ensure thehealth and wellbeing of their cat for the next year,and to ensure they return their cat for its healthcheck at 1 and 2 years of age.

8 WellCat

Life stage focus

In addition to discussions on preventive healthcare, new kitten ownersand 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 differencebetween life stage diets

Introductions – to other cats and/or dogs in the household, if this is relevant

points to cover

It is important to make preventive healthcare visitsworthwhile for clients with

junior cats, to continuebonding them to the

practice and ensure theirongoing compliance with

preventive healthcare

Every opportunity needs tobe taken in a kitten’s first

few visits to bond theclient to the practice

When cats reach their prime, many clients

don’t return them for annual boosters and health

checks – which is why earlybonding to the practice is

so important

Traditionally neutering has been carried out ataround 6 months of age, but recent guidelinessuggest that 4 months of age may be more appropriate to ensure that precocious kittens donot become pregnant at or before 6 months. This will also help to keep contact with the clientby booking in when final vaccinations are complete. Concerns regarding the risks of anaesthesia, and the impact on the cat’s behavioural development, growth and physicaldevelopment, have all received attention, with noevidence being found to suggest that earlier neutering has any negative impacts. For a fullerdiscussion of these issues, see The Cat Group’spolicy statement on the timing of neutering atwww.fabcats.org/cat_group/policy_statements/neut.html

compliance with the preventive healthcare schemeover the ‘prime’ years, as this is the time when clientsare most likely to stop bringing their cat to the vet.

In the case of owners who have just obtained ajunior cat from a rescue organisation, relevantissues that would have been discussed at firstvaccination or neutering may need to be discussedat this stage instead. Ensure you don’t miss thisvital opportunity to provide these owners with theinformation they need to keep their cat healthy,and to bond them to your practice.

Junior (7 months to 2 years)If your clients have brought their cats back to yourclinic for their first and second year boosters, congratulations! You have managed to start bonding them to the practice. It is important tomake these visits worthwhile to ensure their continued

Prime (3 to 6 years)An annual review of preventive healthcare is justas important for cats in their prime: don’t assumethat their lifestyle and preventive healthcarerequirements have remained unchanged.

Cats become socially mature in their prime andtherefore this is usually the stage at which mostbehavioural problems and behaviour-related diseases (eg, idiopathic cystitis) will become evident. Clearly, detecting and addressing anyissues at an early stage, which might otherwise

Clinical signs of illness – the WellCatlog emphasises the importanceof owner vigilance given the often subtle signs exhibited by sick cats

Stress-free trips to the vet – again the WellCatlog discusses howtrips to the vet can be made as pleasant as possible. Further advicecan be found in the Cat Friendly Practice section of www.fabcats.org

Inherited diseases – for pedigree cats, any inherited diseasesencountered in the breed and what to look out for (see www.fabcats.org/breeders/inherited_disorders)

WellCat 9

health plan for lifeThe WellCat Health Chart on pages 6 and 7 provides general guidelines on howoften various parameters should be checked in healthy cats at each of the lifestages. Clearly, the approach will need to be individualised for each cat, particularly if it is unwell.

furtherinfoat www.fabcats.org

FAB Owner Info SheetsNeutering your catCaring for your kittenHand rearing kittensIntroducing your cat to othercats and dogs

At the time of neutering particular attention shouldbe paid in the physical examination to the presence/absence of descended testes and othercongenital defects (eg, umbilical hernia, cleft palateand heart murmurs). It is important that the recording of bodyweight and body condition scoreis initiated and an assessment of the cat’s growthis made. It is also important to review preventivehealthcare at the time of neutering. For example,some owners that initially said their cat was goingto be kept indoors and opted not to have FeLVvaccination may have changed their minds anddecided to let the cat outdoors once neutered.Obviously this will impact on the advice that needsto be given regarding FeLV vaccination.

Dietary advice again needs to be reviewed, and

discussions regarding feeding to prevent obesity arealso well worthwhile.

Other aspects of care that need to be exploredaround this time are the pros and cons of an indoorversus indoor/outdoor lifestyle and, particularly foroutdoor cats, microchipping, cat flaps, and choiceof collars to ensure that only safety collars are used. If the cat is kept indoors exclusively, thenenvironmental enrichment should be discussed inorder to minimise the risk of behavioural problemsand related disease such as idiopathic cystitis (seepage 18). Further advice is available in FAB’s book,‘Essential Cattitude’ (see page 19). Another usefulresource is The Indoor Cat Initiative, run by TonyBuffington and colleagues at Ohio State University –www.vet.ohio-state.edu/indoorcat

For all junior cats, preventive healthcare and dietshould be reviewed. Hopefully most cats will berelatively healthy at this life stage. The most common problems likely to be encountered arerelated to infectious diseases, cat bite relatedinfections, dietary indiscretion and road trafficaccidents. Nevertheless, remember that youngcats can develop serious diseases, too, such asheart disease and infectious disease (eg, felineinfectious peritonitis); even some neoplastic diseases like lymphoma can frequently occur inthis age group of cats. Considering that cats

are so good at hiding signs of illness, any concerns that the owner has regarding theircat’s health should be taken seriously to maximise the chance of detecting seriousproblems early on.

Thorough clinical histories and physical examination at these routine checks can help to pick up problems early on. The WellCatlogprovides questions that owners should askthemselves to alert them to any changes in theircat’s normal habits.

lead to behavioural problems later on, is preferable.

In pedigree cats this may be the age group thatsome inherited diseases become evident, such aspolycystic kidney disease. Be aware of specificdiseases to look out for in certain breeds – seepage 16.

Obesity will become more common in this agegroup, too, and here again prevention is much

better than cure! Regular body condition scoring, weighing and dietary advice will help todetect weight gain early on so that promptaction can be taken to prevent obesity. Ownercompliance with dietary advice will be improvedby emphasising how common obesity is andhow difficult weight loss is to achieve once obesity occurs, and discussing the associatedrisks, such as osteoarthritis, diabetes mellitus,hepatic lipidosis and cardiovascular disease, aswell as increased anaesthetic and surgical risks.

Developmental periods – what owners shouldexpect. An understanding of normal behaviour in cats will help to prevent behavioural problems such as aggression, elimination behaviour andscratching

Neutering – if and when to neuter (see www.fabcats.org/cat_group/policy_statements/neut.html)

Pet insurance – see page 27

10 WellCat

It is important to appreciate and consider variouschanges that occur with advancing age wheneveran older cat is being assessed, investigated ormanaged. Owners also need to be made aware ofthese changes in order to provide the best care fortheir ageing feline friends.

Senses. Vision may decline due to retinalchanges, nuclear sclerosis (lens ageing) and irisatrophy, making the cat sensitive to bright light.Loss of hearing is common, often caused by a lossof spiral ganglion cells. Affected cats may be easilystartled and cry during the night or when left alone.

Chronic renal diseasePriorities for assessment

Urea/creatinine (always interpret with urine specific gravity)Electrolytes (Na+/K+/PO4

–/Ca2+)Proteins (albumin/globulins)HaematologyUrinalysis, including urinary protein:creatinineratio and urine cultureBlood pressure

Considerations when managing casesCorrection of dehydration and optimisation offluid intake. Initially intravenous fluids may berequired, followed by subcutaneous fluids orincreased oral fluid intake (see page 28)Dietary modification (restricted phosphate andprotein)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)

Treatment of urinary tract infectionTreatment of proteinuria (benazepril)

HyperthyroidismConsiderations when managing cases

See page 24 for important laboratory considerationsRemember to assess the patient for hyperthyroid complications (eg, hypertension,heart disease) and concurrent disease whendeciding on appropriate treatment optionsIf considering surgery, discuss with the ownerthe possibility of ectopic thyroid tissue, risks ofincomplete removal, and complications of surgery (eg, hypoparathyroidism)When considering medical therapy, discuss potential side effects of treatment (eg, vomiting, anorexia, hepatopathies, facialpruritus and haematological disorders), andensure appropriate monitoring for side effectsConsider discussing referral for assessment ±radioactive iodine treatment, where appropriateConsider impact of treating hyperthyroidism on any pre-existing renal disease and ensureadequate monitoring

Diabetes mellitusDiabetes mellitus is most likely to develop as catsreach the mature stage of life, and so particular

It will come as no surprisethat chronic renal disease,hyperthyroidism, diabetesmellitus, osteoarthritis and

neoplasia are recognised asbeing the ‘top 5’ significant

conditions of mature, seniorand geriatric cats. Here are

some priorities and pointersfor their day-to-day

management

A cat’s sense of taste may reduce as it ages andtherefore food preferences may change. Sense ofsmell 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. Ageingresults in loss of lung compliance and fatigue of respiratory muscles, with a consequent reduction inoxygenation. Cardiac disease is also not uncommonin older cats – both primary cardiomyopathies andsecondary cardiac changes associated with ‘old cat’diseases such as hyperthyroidism and hypertension.

Gastrointestinal system. Gastrointestinal function may decline, necessitating a highlydigestible, nutrient-dense diet. Vomiting and diarrhoea can commonly result from systemic (eg, hyperthyroidism) or neoplastic disease (eg, gastrointestinal lymphoma). Mild constipation isalso common in older cats, often resulting from acombination of factors, such as reduced colonicmotility, mild dehydration, or reluctance to use the litter tray/go outdoors (eg, due toosteoarthritis).

Oral cavity. Periodontal disease, odontoclasticresorption lesions and tooth loss are common andcan contribute to inappetence, halitosis and

Life stage focus

older cat diseases

Mature, senior and geriatric (7 to 10 years, 11 to 14 years and 15 years+)

Mature cats may well appearas though they’re still in their

prime, but they start tobecome at increased risk of

‘older cat’ diseases. More vigilant monitoring is required

on the part of vet and owner alike

Most senior cats are notperceived by their owners

as being elderly. Ageing changes are oftensubclinical, and may onlybe apparent to the owneras increased sleeping or

decreased activity

WellCat 11

attention should be directed at looking for earlysigns of diabetes, especially in at-risk cats.

Risk factorsObesityIndoor lifestyleCorticosteroid/megestrol acetate treatmentBreed – Burmese cats are predisposedSex – male cats are predisposed

Regular urinalysis to detect glucosuria is warranted inolder cats displaying one or more of these risk factors.

OsteoarthritisOsteoarthritis is now known to be much morecommon in cats than previously thought. The clinical signs are often very subtle and radiographicchanges may be found incidentally. Cats rarelypresent with overt lameness and the clinicianmust probe for important historical informationreflecting impaired mobility (see page 12).

Considerations when managing casesEnvironmental changes (see WellCatlog, page28, for further information)Weight loss, if requiredAnalgesiaDietary management (see page 28)

NeoplasiaNeoplasia is inevitably diagnosed more frequentlyin older cats. Fortunately, developments in oncology mean that some forms of neoplasiacan be managed, allowing the cat to maintain a good quality of life with relatively few sideeffects. If a neoplastic process is suspected it is obviously very important that an accuratediagnosis is reached using cytology and/orhistopathology.

Considerations when managing casesSurgical resection of suspected neoplasticmasses should be carefully planned to achievethe best possible result, as the first surgeryoffers the greatest prospect of completeremoval. Referral to a specialist may berequiredEffective staging will allow for treatment planning and will provide information on prognosisOwners should be made aware of the prognosis and costs involved before startingany treatmentDiscussion regarding euthanasia is appropriatebefore the situation arisesAn oncologist should be contacted for further advice if there is any uncertainty about treatment options

Skin and claws. The skin of older catsbecomes thin and lacking in elasticity, which canmake assessment of hydration difficult. Reduced grooming can result in a poor haircoat. Clawsbecome brittle and overgrow due to reducedactivity, requiring regular trimming.

Immune system. Immune function may declinewith age, leading to increased susceptibility toinfection.

With geriatric cats, the ageingchanges are much more apparent to the owner, whocan clearly appreciate thattheir cat has become old

dysphagia. Oral cavity neoplasia also occurs in the older cat and can be easy missed without thorough examinations.

Musculoskeletal system. Muscle mass reduceswith age and can result in weakness. Bone densityand cartilage quality also diminishes, contributingto the development of osteoarthritis.

Renal system. With age the kidneys reduce in size and weight, glomerular filtration ratereduces and the renal tubules atrophy. This leads to the formation of dilute urine, which inturn predisposes to urinary tract infection.Incontinence can be encountered in older cats;so too can inappropriate urination as a result ofbehavioural changes.

Central nervous system. Ageing changes within the central nervous system may result inbehavioural change (eg, cognitive dysfunction leading to apparent senility). This may leave the catdisorientated and reluctant to interact with familymembers and other pets.

+)

Pharmacological considerationsAgeing can affect theabsorption, distribution,metabolism and eliminationof drugs. Absorption fromthe gastrointestinal tractmay be reduced, as may absorption from subcutaneous and intramuscular sites.Changes in the proportionof body fat may affect drugdistribution, and reducedrenal and hepatic functioncan affect transformationand elimination of drugs.Older cats receiving severalmedications may sufferfrom drug interactions. Drugdoses should be reduced in animals with known renalor hepatic disease.

furtherinfoat www.fabcats.orgFAB Owner Info Sheets

The overweight catChronic kidney (renal) failure in catsGiving subcutaneous fluidsto cats – an owner’s guideCaring for the elderly catHyperthyroidism in catsManaging the diabetic catArthritis in catsCancer in cats (1) – what isit and what are the common cancers in cats?Cancer in cats (2) – howcan cats be treated?High blood pressure(hypertension) in catsConstipation in the cat

furtherinfoat www.fabvets.orgFAB Clinical Protocols

Hyperthyroidism 1:Radioiodine therapyHyperthyroidism 2: With chronic renal failureHyperthyroidism 3: Postoperative hypoparathyroidismSubcutaneous fluid therapyCOP chemotherapy forfeline lymphoma

FAB Veterinary FactsheetsCare of the older catOsteoarthritis in catsDiabetesNSAIDs

THE WellCat for life clinical history form, shown opposite, can be photocopied, or downloaded fromwww.fabcats. org/wellcat/for_life, and used in the practice to make collecting full standard histories easier. Practices may choose to hand these forms toowners to fill out as far as possible before bringing theircat in, or they may organise for a nurse or member ofsupport staff to collect the history using the form.

To get a full picture of the cat’s state of health, it is vitalnot to overlook mobility and behaviour.

Questions relating to mobilityOnce cats reach the mature life stage, the risks ofosteoarthritis begin to increase. The checklist belowwill help to detect early signs. It is based on a questionnaire, produced by Hill’s Pet Nutrition, whichis included in the WellCatlog to encourage owners tothink about and evaluate their cat’s mobility; ownersare asked to consider whether their cat shows thesevarious signs ‘all of the time’, ‘some of the time’ or‘none of the time’.

Questions relating to behaviourThere are a number of questions (see left) that canusefully be asked at routine health checks to pickup behavioural issues as early as possible. Equally they will be helpful in cats with suspectedbehavioural problems.

History takingNote that many owners will not recognise signs of conflict in their cat(s) – hence the inclusion of thelast question on problematic interactions. For further discussion on this aspect, and some pointers on which to base questions about thecat’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 mayhave a condition that is associated with this behaviour,such as idiopathic cystitis, or arthritis which is makingit difficult to get into the litter tray. Similarly, a cat thatpresents with anorexia and lethargy may have anunderlying medical problem; alternatively it may bestressed by changes in its environment.

Questions relating to specific problemsIf the cat is showing any specific clinical signs (eg, vomiting or coughing), the owner will need moredetailed questioning. Ask about:

Duration of clinical signsOnset – acute versus chronicFrequency of clinical signsFeatures/timing (eg, is vomiting always after food?is the cough productive?)Whether signs are getting worse, better or remaining the sameAny improvement with medicationPresence 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?

mobility checklist

12 WellCat

behavioural checklist

Does your cat urinate ordefecate outside the littertray?

Does your cat spray?(Spraying occurs when a cat backs up to a verticalsurface, kneads with its feet,and flicks the tail tip whileprojecting urine)

Does your cat show signsof aggression to people,including hissing, biting orscratching? If so, are thesedirected towards any specificfamily members? Tostrangers?

Does your cat exhibit any fearful behaviours thatconcern you?

Does your cat show anydestructive behaviours, suchas scratching or chewingobjects in the home?

Has there been anychange in your cat’s behaviours or disposition?

Does your cat have anyproblematic interactions withother cats or pets in thehousehold or neighbourhood?(see page 18)

WellCat 13Additional clinical history forms can be downloaded from www.fabcats.org/wellcat/veterinary

BACKGROUND

Age: ....................... Sex: ............... Breed: ................................................... Time in owner’s possession: ..................................

Acquired from: Breeder Rescue centre Other: .........................................................................................................

Other cats: No Yes How many? ..................... Any problems? ..............................................................................

HABITAT

Environment: Indoor Indoor/Outdoor Limited outdoors In at night Outdoor only

Litter tray: No Yes Type of litter used: .........................................................................................................

Cat fighting: No Yes ...............................................................................................................................................

Hunting: No Yes ................................................................................................................................................

Access to toxins: No Yes ................................................................................................................................................

NUTRITION

Last fed: ........................................ am/pm

Diet: Dry cat food Wet cat food Both Other ...................................................................................................

Food type/brand normally fed: ..................................................................................................................................................................

Favourite foods or dislikes: .......................................................................................................................................................................

ROUTINE PREVENTIVE HEALTHCARE

Vaccinations: FHV/FCV/FPV FeLV

Last vaccination given: ≤15 months <36 months >36 months Never Unknown

Worming (which product and when): ........................................................................................................................................................

Flea treatment (which product and when): ................................................................................................................................................

Retrovirus status: FeLV+ FeLV– FIV+ 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: ................................................................................................................................................................................................

WellCat for lifeDate: ................. Case number: ................... Cat’s name: ...........................................Owner’s name: ..................................................... Clinician: ................................................

Clinical history

IT IS ALL well and good knowing what should bedone in every physical examination, but whetherthe cat will allow a thorough examination isanother question! Assuming your patient hasarrived on the consulting room table without toomuch anxiety, the way in which you go about thephysical examination will determine whether youglean a great deal of useful information – or littlemore than the size of its canine teeth, the sharpness of its claws and the sound of growlingthrough a stethoscope! It may also determinewhether the owner will bring the cat back in forits next routine health check or whether theychoose to avoid the practice at all costs – atleast until their cat is seriously ill.

Examination tipsBe flexible. The key is to find out what makes

the cat more relaxed, and adapt the place/position/way that you do the physical examinationto suit the individual cat.

Don’t rush. Never be in a rush when examininga cat. A little extra time does need to be allowed tokeep the cat’s patience. This is a classic exampleof more haste less speed – the longer you cankeep the cat’s patience, the more you will get outof a physical examination.

Use gentle persuasion. Cats like to be in control; they don’t take kindly to being told whereor how they are going to stand. Use gentle persuasion to trick the cat into thinking it is just onthe table for some pleasant fuss and attention. Aimto complete the majority of the physical examination

without the cat realising you are doing anything morethan just stroking it.

Let the cat choose. Some cats will be happierbeing examined on their owner’s lap, others will bemore relaxed on the floor. A window can provide agood distraction and some restless cats will morehappily stay still on a window ledge than on thetable. Others may prefer to stay sitting in their carrier for as long as possible. Very nervous catsmay prefer to hide under a blanket for as much ofthe examination as possible.

The preferred position. Some cats prefer to liedown, others prefer to stand. Try to carry out asmuch of the examination as possible with the catin its preferred position. It will stay patient for muchlonger than if you try to force it into a position thatyou want it in.

Apply minimal restraint. As soon as you try to holda cat still, it anticipates something terrible is going tohappen. Try not to restrain the cat more than simplyplacing a hand in front of it to stop it jumping off thetable. Split the examination into short sections and inbetween allow the cat to change positions, have alook around, etc. As soon as the cat begins to getrestless give it a break to relax – just a few seconds fora stroke or a walk around the table.

Avoid direct visual contact. Perform as much ofthe examination as possible with the cat facingaway from you, making sure to avoid direct visualcontact. The cat will feel more secure if it is satagainst you, facing away. Avoid loud or suddennoises 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 handlinguncomfortable. The hypertensive or hyperthyroidcat may feel anxious and require a more cautiousapproach and minimal restraint.

Last things last! Leave taking the cat’s temperature and opening its mouth to the end ofthe examination if these are likely to distress it.

A case for sedation?Some cats are so fearful that the above is simplynot achievable even with the most patient of handling. These animals are the minority, thankfully,but if you encounter one try not to heighten its fearby scruffing and pinning it to the table; consider ifchemical restraint is appropriate. If the cat doesneed to be sedated, ensure you get as much information as possible while it is sedated! Thismay include an oral examination, cystocentesis,blood sampling and imaging, if appropriate.

No amount of cat handling talent will transform a wide-eyed hissing monster into a calm relaxed feline patientwithin the time constraints of a routine consultation! Clearlythe way in which the cat is brought to the surgery, the typeof carrier, the reception and waiting areas, and the routinein the consulting room all have an impact

FAB’s Cat Friendly Practicecampaign has generated awide range of invaluablepractical advice for reducinganxiety and stress in catsand making them moreamenable patients – twobooks’ worth to date. Thesecan be downloaded fromwww.fabcats.org

Physical examination

14 WellCat

learning frompractice

Temperature: .................. Pulse rate: ...................... Respiratory rate: ..............

1 BODYWEIGHTCurrent (kg): ................ Previous (and date): ....................... % change: ...............

2 BODY CONDITION SCORE 1 Very thin 2 Underweight 3 Ideal weight 4 Overweight 5 Obese

3 ATTITUDEBright and alert Quiet but alert Lethargic Dull Hyperactive

Other: ...................................................................................................................

4 FACENormal Head tilt Abnormal (eg, wounds, swelling, asymmetry) ...................

5 EYESFully open, bright, clear of discharge, swelling and redness

Pupils normal size, symmetrical, normal pupillary light reflex

Conjunctiva and sclera: Normal Pale Hyperaemic Icteric

Abnormalities (cornea, iris, lens): ......................................................................................Retinal exam required? No Yes Findings: ...............................................

6 EARSNormal Abnormal (smell, discharge, wax, mites): ...............................................

Otoscope examination required? No Yes: .................................................

7 NOSENormal Abnormal (swelling, asymmetry, discharge – one or both nostrils, purulent/

serous/haemorrhagic): ......................................................................................................

8 HYDRATIONSkin tenting: Normal Abnormal

Mucous membranes: Normal Dry/tacky % Dehydrated: .........................

9 MOUTHDentition: Deciduous Adult Abnormal eruption? Yes No

Tartar: Mild Moderate Severe

Gingivitis: Mild Moderate Severe

Stomatitis: Mild Moderate Severe

Tongue: Normal Abnormal (ulcers, masses, foreign bodies wrapped around)

Palate: Normal Abnormal (ulcers, masses, foreign bodies)

Pharynx and tonsils: Normal Abnormal (inflammation, foreign bodies, masses)

...........................................................................................................................................................

10 MUCOUS MEMBRANESPink Pale Icteric Congested

Capillary refill time: Normal Abnormal: .......................................................

11 SUPERFICIAL LYMPH NODESSubmandibular: Not palpable Palpable Enlarged

Prescapular: Not palpable Palpable Enlarged

Popliteal: Not palpable Palpable Enlarged

12 NECKPalpable goitre: No Yes ⇒ Unilateral Bilateral

Size and position: ........................................................................................................................

13 RESPIRATORY TRACTRespiratory rate and effort, noise: Normal Abnormal .................................

Anterior rib spring: Normal Reduced

Percussion: Normal Dullness Increased resonance

Auscultation: Normal Abnormal (wheezes, crackles, increased lung sounds)

...........................................................................................................................................................

14 CARDIOVASCULAR SYSTEMHeart rate: ..................

Heart apex beat: Normal Abnormal (displaced? any thrill?)

Rate/rhythm: Bradycardia Tachycardia Gallop Dysrhythmia

Murmur: No Yes ⇒ grade: .........../VI Systolic/diastolic

Point of maximum intensity? L/R, base/apex

Pulse: Normal Weak Bounding Deficits

Difference between L and R pulses? Yes No

15 ABDOMENCompression: Normal Abnormal (mass, pain)

Liver: Normal Abnormal (enlarged, mass, firm/soft, irregular, pain)

Kidneys: Normal Abnormal (inc/dec size, irregular, unequal size, firm, pain)

Intestines: Normal Abnormal (abnormal contents, mass, pain)

Bladder: Normal Abnormal (loss of tone, very firm, distended, thickened, painful)

Other findings (eg, masses, pain): .............................................................................

.....................................................................................................................................

16 COAT AND SKIN (mark abnormalities on diagrams)Coat normal

Abnormal (hair loss, flea dirt, dandruff): ........................

Skin normal

Abnormal (nodules, swellings, lumps): .........................

17 MUSCULOSKELETAL SYSTEMNo concerns

Other (weakness, stiffness, lameness): .........................................................................

Further assessment required? No Yes: ...................................................

18 CENTRAL AND PERIPHERAL NERVOUS SYSTEMSNo concerns Other: ....................................................................................

Further assessment required? No Yes: ...................................................

WellCat 15

WellCat for lifeDate: ................. Case number: ................... Cat’s name: ...........................................Owner’s name: ..................................................... Clinician: ................................................

Physical examination

Additional physical examination forms can be downloaded from www.fabcats.org/wellcat/veterinary

ventral dorsal

SUMMARY (problems, differentials, treatment and monitoring)

ADDITIONAL FINDINGS

16 WellCat

AROUND 10 PER CENT of cats in the UK arepedigree cats – some practices only see pedigreecats that are kept as pets, others have breederclients. There are now certain conditions that weknow to be breed related and many that arethought to have an inherited component. Theseand other breeding-related issues can be a minefield for vets in practice.

Inherited disorders in cats – confirmed and suspectedFAB has just launched an online list of manybreed-related defects in cats, which can be foundat 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 thatappear to have an inherited basis. The conditionsare categorised into:

Those where the genetics have been confirmedand/or a genetic test is available.Those where a breed predisposition is recognisedand the condition is strongly suspected to beinherited.Those where a potential breed predisposition isrecognised but it is not currently known if the

condition is inherited or not, or where there are only single case reports or evidence isanecdotal.

Indications are given on the frequency of occurrence within the particular breed, and whethergeographical differences are known to apply.

The breed-specific section is followed by a moregeneral section that addresses conditions that can

affect many different breeds of cat, and includesconditions that appear to affect certain breedsmore frequently than others (or at least certainbreeding lines of certain breeds). However, some of the conditions in this section may be multifactorial in nature and may possibly resultfrom breed-related management practices and not solely from genetics. References are includedthroughout.

It is important to recognise that all lists of this typehave a number of inherent limitations. Perhaps themost fundamental is the need to understand that theamount of information available for a particular breedis not a reflection of the overall health of that breed.Rather, it will depend to a great degree on the level ofsurveillance within the breed, and on the breed’s longterm popularity or special factors such as a breed’susage in medical research. For example, it would be wrong to contend that the Burmese breed is significantly less healthy than the Tonkinese (which hasfewer disorders listed): it is simply that the Burmese ismore numerous and has an active and vigilant breedclub, while the Tonkinese is less numerous and lessstudied. In fact, much of our information would suggest that, in very general terms, the less popular abreed is, the smaller the available gene pool and themore likely it is (per cat) that there will be inherited disease. In addition, many (and potentially all) of theinherited diseases known in pedigree breeds may alsobe found in mixed-breed cats (albeit typically at alower prevalence).

Screening schemesFAB PKD Screening Scheme

The FAB polycystic kidney disease (PKD) screeningscheme for Persian cats and related breeds wasestablished over five years ago, and was able to showthat 30 to 40% of Persian cats in the UK, like those inmost other countries, were affected by this autosomaldominant disease. The scheme initially used ultrasound scanning to look for cystic holes within the kidneys. Once the gene had been identified, itincorporated buccal mucosal mouth swabs for genetesting. By facilitating the breeding of non-affectedcats, the prevalence of PKD appears to be falling inPersian cats in the UK (FAB data).

FAB/VCS HCM Screening SchemeFAB collaborates with the VeterinaryCardiovascular Society (VCS) to run a hypertrophiccardiomyopathy (HCM) screening scheme forMaine Coon cats and other breeds. This usesechocardiography 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 involvedin about a third of the cases in this breed.Unfortunately, the scheme is limited because thegene test detects only one of many different genesthat may be involved in the development of HCMand echocardiographic changes of HCM do notalways occur until later in a cat’s life.

Breed-related disorders

Veterinarians should counselprospective owners to checkwith breeders as to whethertheir breed of cat has a historyof any heritable conditions,and to request informationabout possible clinical and/orDNA based testing schemes.

furtherinfoat www.fabcats.orgFAB Owner Info and BreederInformation Sheets

Polycystic kidney disease in catsCardiomyopathy in catsPyruvate kinase (PK) deficiencyFeline parturition – when towait and when to worry . . .Feline blood groups andneonatal blood groupincompatibilityChoosing a pedigree kittenFeline acne and stud tailCat ’flu information forbreedersTritrichomonas foetus infection in cats

A manual for breeders is alsoin the pipeline

(due to be published late 2008)

advice toowners

www.fabcats.org/breeders

Body condition score

WellCat 17

Obesity and weight managementOBESITY IS AN increasing problem in cats and hasimplications for longevity. Some studies suggest thatobesity – defined as applying to pets that are 20 percent above their optimal bodyweight – could now beaffecting up to 40 per cent of the cat population.

The rise in obesity in cats is linked to factors such asinactivity and changes in lifestyle. Indoor cats areknown for their inactivity and neutering will also havean effect. Post-neutering energy expenditure reducesby 30% on average. In female cats the metabolic rateimmediately slows after spaying, so if the same food isconsumed in the same quantities, weight gain willresult. Male cats, on the other hand, will experience anincrease in appetite, resulting in food intake increasingby up to 25%, which is also combined with a gradualslowing of metabolic rate.

Dietary manipulation is still the most commonapproach to weight management. The more traditional approach with a high fibre diet helps toregulate food intake through gastric distensionmethods with calorie dilution. A more novelapproach involves the use of a high protein, lowcarbohydrate diet to trigger a metabolic switch inburning fat, while achieving satiety through alteredhormonal signalling. Both dietary approaches alsoinclude the use of L-carnitine, as it has recentlybeen found that high levels of L-carnitine andlysine decrease fat accumulation and help to preserve lean muscle mass. L-carnitine stimulatesthe conversion of fat into energy (less fat is storedin adipose tissue) and more fat is used as a sourceof energy. This has a sparing effect on protein: less protein is used for the production of energyand more can be made available to build musclemass.

Weight loss programmes – some tipsObesity 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 possiblyhypertension).

Feeding diary. Most owners underestimate howmuch their cat is fed. It is useful to ask all the membersof the household to keep a feeding diary for a week, toassess 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. Informationshould be obtained as to how the owners measure thefood, how it is fed (ie, ad libitum or set meals), if the catis on any medication and if so how that is given (extratreats?), and whether the cat has access to anotherpet’s food. Only then can you accurately determinehow many calories the cat may be receiving and calculate its requirement for weight loss.

Goals. Ensure realistic weight goals and timeframes, and make certain the cat is eating the diet youprescribe (see page 28). Be aware of the risk ofhepatic lipidosis if weight loss occurs too rapidly.

Activity levels. Increasing exercise, byeven a small amount, through play or byplacing food in different areas of thehouse, will help considerably.

weights and measures

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 kgcat, 0·5 kg equates to 15% of the cat’s bodyweight, which is certainly significant! Cats can also gain or maintain overall weight whilelosing 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 beguessed or assumed. Different breeds vary dramatically in size: the weight of normal adult cats may range at least from 3 to 6 kg.

scope formoreResearch commissioned byHill’s Pet Nutrition identifiedthat, in about 40 per cent ofcases, vets failed to discussa pet’s excess weight withan owner because they hadobserved that the client wasalso overweight. Over half ofall pet owners questionedfound that it was up to themto initiate the conversationabout their pet’s weight withthe vet, suggesting that thereis still huge scope to tacklethis issue more proactively.

1 VERY THINRibs highly prominent andeasily felt with no fat cover

2 UNDERWEIGHT Bones are raised with

minimal tissue between theskin and bone

3 IDEAL WEIGHTRibs are easily felt

4 OVERWEIGHTRibs are difficult to feel

through moderate fat cover,and there may be a slightlysagging abdominal fat pad

5 OBESERibs are difficult to feel

through thick fat cover, andthere is a prominent sagging

abdominal fat pad

furtherinfoat www.fabcats.orgFAB Owner Info Sheet

The overweight cat

18 WellCat

Preventing behaviour problemsBEHAVIOUR-RELATED PROBLEMS are beingmuch more commonly recognised in general practice. This is likely to stem from better understanding of feline behaviour and improvedrecognition of behavioural problems, a rise in thenumber of cats kept purely indoors, increasingnumbers of multicat households, and the presence of much more densely cat-populatedareas as cats’ popularity as pets continues everupwards.

Historically, behavioural assessment has not formedpart of routine preventive healthcare. However, as ever,prevention is better than cure and so it is important forthe general practitioner to try to recognise factors in acat’s lifestyle and environment that could increase therisks of behavioural problems, and to be able to stepin with appropriate advice for owners that may help toprevent problems developing.

The behavioural checklist on page 12 will help to pickup early indicators/risk factors that could lead to problems. Vets also have an important proactive roleto play in preventive behavioural medicine.

Preventive behavioural medicine1. Ensure that owners are providing for theircats’ environmental needsIt is well worth going through the environmentalchecklist 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 flagup potential problems before they become an issue.

2. Educate owners in recognising conflictbetween catsConflict with other cats in the household or neighbourhood frequently leads to behaviouralproblems, but is underrecognised by owners.Signs of conflict between cats can be open orsilent. Open conflict is easy to recognise – the catsmay stalk each other, hiss and raise their hair, forexample. However, silent conflict can be so subtlethat it is easily missed. The cat creating the conflict(the assertive cat) can be identified as the one thatnever backs away from other cats, blocks othercats’ access to resources and stares at other cats.This cat may only have to approach or stare at athreatened cat for it to leave a resource, such as food

Litter traysFor 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’sfood and with easy access and an escape route? Other cats shouldnot be able to sneak up on a cat in a litter trayAre 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 arefrequent 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 beenconsidered? These are important factors for some cats

Access outdoorsIs there more than one access point in multicat households? Catswill sometimes block other cats’ exit/entry pointsAs far as possible, has it been ensured that cat flaps do not exitonto an exposed area where the cat may be ambushed or worriedabout going out? If the location is inflexible then considerationshould be given to providing coverage with objects such as plantsor boxesCan other cats enter through the cat flap? This can be source ofanxiety. Magnetic collars can be considered but are not problem-free. Magnetic tags are easily lost, resulting in the cat being lockedout. Also the flap takes a few seconds to open, so if a cat is beingchased it may run headfirst into it. Other cats may be able to forcetheir way through the cat flap and then become trapped inside thecat’s house. As an alternative, it is worth considering cat flaps thatelectronically recognise microchips (www.petporte.com)

FoodDoes each cat have its own food and water bowl in a convenientlocation that provides some privacy while eating or drinking, and anescape route?Are bowls located such that another animal cannot sneak up on thecat while it is eating?Have cats’ natural feeding behaviours been considered? Predatory

Environmental checklistactivities, such as stalking and pouncing may be simulated by hiding small amounts of food around the house or by putting dryfood in a container that the cat has to extract individual pieces fromor move about to dispense the food

WaterDoes the cat have a preference for running/dripping water?Does it prefer glass/metal/ceramic bowls of a cer-tain shape/size?Does it have a preference fortap water, rain water, puddlewater or bottled water?

Other considerationsAccess to owner. Does the cat actively seek human contact, ordoes 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 anescape route? Are other animals able to sneak up on the cat whileit rests?Passing places. For multicat households, does the cat have a wayof getting past another cat that may be blocking a corridor/ stairway, etc?Scratching surfaces. Is the cat provided with horizontal and verticalscratching surfaces? The latter will need to be at least the height ofthe cat at full stretchHiding places. Is the cat able to hide/get up high if needs be? It isimportant that the cat feels safe in its chosen spot, and is notremoved from it or annoyed while hiding thereInteraction and play. Does the cat prefer to be petted and groomedor does it prefer play interactions? Some cats enjoy playing withtoys, particularly those that mimic prey. Many cats also prefer novelty, so a variety of toys should be provided and rotated orreplaced regularly to maintain interest

Extra consideration needs to be given to environmental enrichment and stimulation for indoor-only cats

Cats under stress may develop abnormal coping behaviours or displacementbehaviours, such as overgrooming, pica, hyperphagia and polydipsia.Some cats will experiencehyperaesthesia, where theskin ripples due to heightenedactivity of the sensory nervesin the skin. Other disordersrelated to stress include idiopathic cystitis, inappropriate urination/defecation, scratching asmarking, and spraying.

stress-relateddisorders

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 vaccinationand antiparasitic treatments is important, weighingup the risks and benefits of treatment against the lifestyle of the cat, and disease and, where relevant, any zoonotic implications.

VaccinationsDespite the success of vaccination, all the diseasesthat 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 furtherreducing the prevalence and severity of disease.

Despite the importance of vaccination, adverse reactions to vaccines do occur, and that is a cause for some concern. All suspected adverse reactionsshould be reported to the Veterinary MedicinesDirectorate, www.vmd.gov.uk. Most adverse reactionsare mild, but severe adverse reactions such as injection site sarcomas are possible. In the USA, vaccine-site sarcomas have been recognised for anumber of years and are thought to occur at a rate of approximately 1 per 10,000 doses of vaccineadministered. Studies on injection site sarcomas inthe UK are currently underway. Still, serious adversereactions are extremely rare and the benefits of vaccination far outweigh the risks involved. However,as vaccination inevitably carries some risk of sideeffects the use of discriminatory vaccine policies isadvocated – whereby the risks and benefits of vaccination are carefully evaluated and discussed forthe individual cat when determining with its owner thetype and frequency of vaccination that is most appropriate, rather than necessarily vaccinating allcats against all diseases where a vaccine is available.

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 indoorsand is in a single cat household has no appreciable risk of exposure toChlamydophila felis or FeLV infection.

Routine preventive care

or a litter tray. Threatened cats often spend increasingamounts of time away from the family, staying inareas of the house that others do not use. The mostcommon cause of conflict between indoor-housedcats is competition for resources such as space,food, water, litter trays, perches, safe places or attention from people.

3. Talk to breeders about geneticsGenetics have an influence on behaviour.Encourage breeders not to breed from fearful animals or those with known behavioural problems.

4. Talk to breeders about socialisationCats’ behaviour is largely influenced by learningand they make particularly strong associations intheir early weeks of life during the socialisationperiod. Between 2 and 7 weeks of age strongconnections are made in the brain between whatis going on in the environment and how the catfeels about it. Therefore, all of the sights, soundsand experiences that the cat learns about will helpdevelop a template of ‘normal’ life. The fearresponse in kittens starts to develop at around 6 weeks of age.

5. Follow Cat Friendly Practice principlesIf vets and nurses treat cats gently and calmly during consultations and hospitalisation it will helpprevent 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 clientsto the practice and to increase owner take-up ofpreventive healthcare.

FAB has worked with its feline behaviour panel to put together a beautiful book called ‘Essential Cattitude – aninsight into the feline world’, which will help readers to‘think cat’ and consider things from the feline point ofview. It is available for purchase, or can be downloadedfor free, from www.fabcats.org

In the primary vaccination course, consideration should be given to anadditional vaccination at 16 to 20weeks of age, since many kittensmay still have maternally derived antibodies at 12 weeks of age, andthis can be a cause of vaccine failure

furtherinfoat www.fabcats.orgFAB Owner Info Sheets

Spraying and soiling indoorsMoving house with catsIntroducing your cat toother cats and dogsScratching or clawing in thehouse

WellCat 19

E S S E N T I A L CAT T I T U D Ean insight into the feline world

To assist vets in suggesting rational control measures, the ESCCAP identifies risk factors for the principal internal worms and protozoa ofcats. 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 lifecycle, characteristics, geographical distribution,clinical signs and diagnosis, are available atwww.esccap.org

In the clients’ WellCatlog we suggest, as a broadapproach, that kittens are frequently treatedagainst roundworms from about 6 to 16 weeks of age, and that adult cats are treated regularlyagainst 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.

Flea treatmentsThere is no doubt that committing the practice to making a real effort to advise pet owners tomanage flea control properly will have a positiveimpact on both the health of pets and the financialdynamics of the practice. Yet, despite their bestintentions, many practices simply don’t get aroundto giving pet owners advice on flea control in anyroutine fashion.

During this process avoid merelyreferring to ‘spot-ons’. Cat ownersbuying ‘spot-on’ products in theirsupermarket may very well not get the efficacy that you may feel is embodied in that term, norunderstand why. Furthermore, theywill not be advised to avoid usingdog products on cats or to keepcats away from treated dogs forsome time if the dog preparationcontains permethrin.

Most cat owners do perceive veterinary advice to be useful andinformative. Given the opportunity tounderstand the facts, most view thevet as the best source of effectiveflea treatment – for their home aswell as for their cat. Using initiativessuch as National Flea Week(www.nationalfleaweek.com) asmarketing tools can help the practice to highlight flea control.

Encourage owners to find out moreabout the different flea productsavailable and how they work bygoing to www.fabcats.org/owners/fleas

‘Core’ versus ‘non-core’ vaccinesThe American Association of Feline Practitionershas recently suggested considering feline vaccinesas either ‘core’ or ‘non-core’. Core vaccines wouldbe those for which routine use can be justified in allcats based on the prevalence of infection, the possibility of indirect transmission and the severityof disease. Non-core vaccines would be vaccinesthat are potentially very valuable in certain situations where cats are at genuine risk of exposure to the organism, but which it is difficult tojustify using in all cats (eg, Bordetella vaccination).

Levels of protectionClients should be informed of the level of protection given by vaccines. Vaccination againstfeline parvovirus, for example, confers a high levelof protection against infection and subsequent disease. Conversely, vaccination against feline calicivirus (FCV), feline herpesvirus (FHV-1) andChlamydophila, although having a major role inprotecting cats from disease and reducing theseverity of disease in infected animals, does notnecessarily prevent infection with these viruses;vaccinated cats can also become carriers of theviruses and pass them on to others.

Booster intervalsRecently the necessity for annual booster vaccinationshas been questioned, and some suggestions madethat the frequency of vaccination for feline parvovirus(FPV), FCV and FHV-1 should be reduced to every 3years. However, at present, there is insufficient dataavailable to determine optimum booster intervals in adult cats, and any decisionregarding reducing booster frequencies should be made afterdiscussion and with informed consent of the owner. Vaccination ofadult cats should nonetheless beassessed at least once yearly and, ifnecessary, modified on the basis ofan assessment of their risk.

Worming treatmentsSome cats are more likely to haveparasite infections than others but,according to the ESCCAP (EuropeanScientific Counsel Companion AnimalParasitology), an independent advisory board recently set up to promote a consistent approach toparasite control in pets in Europe, thedifference is rarely absolute. Hencethe need to provide all cats withappropriate worm control throughouttheir lives. Also, as it is difficult to control where outdoor cats defecate,particular attention needs to be given to worm control in cats to minimise the infection pressure to humans (zoonoses) and other animals.

A review of 286 cases of poisonings notified to theVeterinary Poisons InformationService where canine spot-onpermethrin preparations hadbeen used on cats reportedthat 88% of the cats sufferedneurological signs, and 10·5%died or were euthanased.Startling as these data appear,the VPIS considers that theyprobably underrepresent thescale of the problem. Thepaper, published in the Journalof Feline Medicine andSurgery in 2007, can beaccessed at

www.fabcats.org/esfm/permethrin.pdf

For advice on managing permethrin poisoning cases see

www.fabvets.org/info_sheets/permethrin.html

permethrintoxicity

furtherinfoat www.fabcats.org

FAB Owner Info SheetsTackling fleas on catsWorming your catVaccinating your catFeline immunodeficiencyvirus (FIV)Feline infectious peritonitis(FIP)Feline leukaemia virus (FeLV)Feline upper respiratorytract disease – cat fluChronic nasal discharge in the cat

Advice on choosing a wellconstructed and

managed cattery will helpclients avoid high-risk infectious situations.

Send clients to www.fabcats.org

to choose from almost 200FAB Listed Catteries.

20 WellCat

Routine preventive care

WellCat 21

HYPERTENSION IS COMMONLY recognised inolder cats. There are likely to be several reasonsfor this including a heightened awareness ofhypertension as a feline problem, better access to diagnostic facilities and, possibly, an increasedprevalence of the condition related to the increasing age profile of the cat population.

Blood pressure should be routinely monitored inolder cats (see WellCat Health Chart, pages 6and 7), as well as in any cat presenting with a condition or clinical signs that may be associatedwith hypertension, such as renal disease, hyperthyroidism, heart disease, neurological signs, blindness, hyphaema and suspected hyperaldosteronism (these cats may also have hypokalaemic polymyopathy). Althoughhypertension must be considered in these categories of patients, it is also very important notto misdiagnose hypertension and intervene inappropriately. Cats are particularly prone toincreases in blood pressure associated with stress,which means that blood pressure measurementscan be difficult to interpret.

Measuring blood pressureIt is vital to ensure the patient is as least stressedas possible at the time of measurement. Choose a quiet room, away from barking dogs and telephones, and ideally allow the cat a minimum of10 minutes to acclimatise to the surroundingsbefore measurements are taken. Then restrain the cat as gently as possible for the procedure –usually all that is required is steadying of the catwhile 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 FriendlyPractice booklets (see page 14).

Interpreting blood pressureSBP greater than 200 mmHg

In a typical ward or consulting room situation, 200mmHg should be taken as the absolute upper limit ofnormal using the Doppler technique. Therefore, ingeneral, cats with a systolic blood pressure (SBP)reading in excess of 200 mmHg can be regarded asbeing hypertensive and therapy is justified.

However, some healthy cats may transiently havea SBP marginally above 200 mmHg. It is thereforeprudent to recheck SBP in a cat with a pressureslightly above 200 mmHg where no signs of hypertensive disease are present. Ideally, measurements should be performed several times

on separate days to ensure that the elevated SBP is a persistent finding before commencingantihypertensive therapy in these cats. Signs ofhypertensive retinopathy should also be looked forto provide further evidence of true hypertension. Ifany ocular signs consistent with hypertension areidentified, the hypertension should be consideredsignificant and treatment commenced immediately.

SBP between 180 and 200 mmHgNot all hypertensive cats will have a SBP that ispersistently above 200 mmHg, and therefore thereis an overlap between the ‘normal range’ of bloodpressures in healthy cats and those found inhypertensive cats.

In general, cats with SBP readings between 180 and 200 mmHg should be regarded as potentiallyhypertensive patients. If there is evidence of hypertensive disease (especially ocular signs), or if the cat is known to have chronic renal failure or anyother condition associated with hypertension, thenantihypertensive therapy is justified. In the absence ofthese findings it can be difficult to establish whetherthe cat is normal and presumably stressed, thus having a higher SBP, or truly hypertensive. In somecats 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 mmHgMost normal cats have SBP readings of between130 and 180 mmHg. In those cats known to have acondition predisposing them to hypertension, it isuseful to monitor trends in SBP readings: if it is clearthat the SBP is rising then therapy is warranted onceit exceeds 170 mmHg. Therefore, for example, incats with renal disease and hyperthyroidism it is prudent to maintain SBP below 170 mmHg.

Blood pressure

Ophthalmic examination can be a useful diagnostic aid. In early cases of hypertension,subtle changes such as thedevelopment of focal areas ofperivascular retinal oedemamay be seen. More dramaticchanges would include serousor haemorrhagic retinal detachment and intraocularhaemorrhage. Abnormalities areusually detected in both eyesalthough may be more severein one. In many cases, the catis only presented once severedisease is present and may be blind already. Over a long period of time, retinal degeneration may develop andcan be recognised as areas ofhyperreflectivity

furtherinfoat www.fabcats.orgFAB Owner Info Sheet

High blood pressure(hypertension) in cats

furtherinfoat www.fabvets.org

FAB Clinical Protocol Blood pressure measurement in consciouscats

FAB Veterinary Factsheet Choosing and using ablood pressure monitor,treatment and monitoringof hypertension

22 WellCat

VETERINARY SURGEONS AND NURSES will bewell aware of how common dental disease is incats. Clearly, therefore, this is an area where preventive care and early management can havean important impact on cat health and quality of life. Client education is fundamental to this – particularly as the cat’s ability to disguise pain meansthat 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 haveregular dental check-ups and act on any veterinaryadvice for dental care early in the course of disease.

Cats’ mouths are not the easiest area to examinein a consultation but as it is more common to findpathology than health in the mouth, a thoroughoral examination is a vital part of every physicalexamination.

Tips on performing a thorough oral examination are given below. Bear in mind that the cat withdental disease will be painful and this can hinderexamination. Cat Friendly Practice principles willapply (see page 14). It is important to be awarealso that dental radiographs are especially important in cat dentistry (see www.fabvets.org).

Examination under anaesthesiaOnce dental disease is identified a full examinationunder general anaesthesia is required. Completionof a dental chart (see opposite) is an essential partof this process in order to record the presence ofhealth and/or disease in a form that can be usednow and later.

Why chart? It is important to know which teeth and whatpathology is present before treatment is started.‘Missing teeth’ may be highly significant; the rootsmay be retained or the tooth may have undergoneresorption. 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 informationgathered before initial therapy.Clinically it is a good habit to develop as itrequires every tooth to be examined at everydental procedure. Therefore, problems are notlikely to be overlooked.Charts can be used to help clients understand theneed for them to play their part in maintaining thehealth of the oral cavity of their cat.

Common oral diseasesPeriodontitis (gum

disease). This is caused bythe accumulation ofplaque (a mixture of bacteria in a glycoproteinmatrix) at the gum margin.Gingivitis occurs as aresult of the bacterialimpact and, if left untreated, will progress to periodontitis, inflammationand loss of the supporting structures of the tooth.

Feline resorption lesions. The incidence of resorption lesions (‘neck lesions’) has been reported tobe as high as 54% in cats with dental disease. The

exact cause remainsunknown but thisappears to be a complexdisease with severalinteracting causal factors. Two types ofresorption lesions areseen – those where thelesion remains confinedto the cemento-enamel

junction, with no root resorption and ankylosis of thetooth root, and those where the resorption processinvolves the root, resulting in root resorption, ankylosisof the tooth root, and replacement of the resorbingroot with bone. The two types are indistinguishable

Start by gently lifting up the upper lip to examine the labial surface ofthe teeth on each side and to check oral mucous membrane colour andmoistness, and capillary refill. The upper lip can be pushed up gently withthe thumb in the commissure region to examine the upper molars fully

With the cat sitting on the table, tip the nose dorsally by gently graspingfrom above with the thumb and forefinger over the respective zygomaticarches. The lower jaw will drop open slightly, just enough for you to slidethe tip of your thumb or finger onto the lower incisors to gently depress themandible. Alternatively the thumb and forefinger can be placed further rostrally, just caudal to the upper canines on each side; again the head istilted back, as described above, so the lower jaw can be opened. Thisallows the tongue, palate and lingual surfaces of the teeth to be examined

Some cats twist their head sideways when attempts are made to opentheir mouth, making a complete oral examination difficult. Others will usetheir claws to push your hands away. If the latter occurs, ask an assistantto gently hold the cat’s forelegs just above the elbow. This provides goodcontrol of the forelimbs and will help prevent you getting scratched

The oral examination should be completed by pushing up at the base ofthe tongue in the intermandibular region while holding the head, as describedabove. This allows examination of the lingual frenulum and underside of thetongue, a common place for linear foreign bodies to lodge

Feline dentistry

Oral examination

A low priorityIn a study of over 15,000cats and 30,000 dogs examined at veterinary practices in the USA (JAVMAvol 214, pp1336-1341), themost common findings by far were dental calculus(affecting 24·2% of cats) andgingivitis (13·1% of cats).Despite these findings, fewerthan 4% of animals with oraldisease arrive with an ownerhistory of the problem. In thisparticular study, none of thereasons given by over 47,000owners for requesting a veterinary examination indicated any concern withthe mouth.

WellCat 23

CI

GI

Other

109 108 107 106 104 103 102 101 201 202 203 204 206 207 208 209

FELINE DENTAL CHART

GI (Gingivitis Index)0 = Normal: no inflammation1 = Marginal gingivitis: red line/oedema2 = Bleeds on gentle probing. Swollen3 = Severe inflammation. Spontaneous bleeding

CI (Calculus Index)0 = No calculus either side tooth1 = Up to 25% cover bucally above/below gingiva2 = From 25%-75% cover on buccal crown3 = From 75%-100% cover on buccal crown

Produced by Pfizer Animal Health with the kind assistance of Norman W. Johnston BVM&S FAVD DipAVDC DipEVDC MRCVS

CODE KEYMissing Tooth

X Extracted ToothP (mm) Periodontal PocketFX Fractured Tooth

F Furcation Exposure (F1, F2, F3)GH Gingival HyperplasiaGR Gingival Recession

(Draw line to indicate exact buccal location)RD Persistent deciduous tooth (draw position)

XR X-ray of tooth takenAT AttritionOM Oral massOD OdontoplastyGVP Gingivoplasty

R MAXILLA L

R MANDIBLE L

CI

GI

Other

409 408 407 404 403 402 401 301 302 303 304 307 308 309

FORL'S (FORL – state type and class eg FORL 2/4) Requires X-RayType 1: Focal resorption in crown/roots: Most of root/PL intactType 2: Total resorption of roots & replacement by boneClass 1 = 0.5mm lesion in enamelClass 2 = penetration into dentineClass 3 = penetration into pulpClass 4 = major destruction of toothClass 5 = crown lost/roots retained

ANIMAL’S NAME

OWNER’S NAME

BREED

AGE

SEX

NUMBER

DATE

Palatal

Buccal

Buccal

Lingual

Buccal

Buccal

Treatment Recommendations

AH229/04

Reprinted with permission, courtesy of Pfizer Limited

24 WellCat

clinically and intraoral radiographs are necessary to identify the lesion present anddetermine the appropriate treatment.

Chronic gingivostomatitis. This is anothercomplex disease, which is thought to be anaberrant immune response to plaque accumulation on the tooth. Cats with

chronic gingivostomatitis are often difficult to treatand a thorough examination, routine blood tests,dental examination and radiographs are necessaryto identify possible underlying causes and establisha treatment plan. Often multiple extractions arerequired to reduce the bacterial load in the mouth.

Fractured teeth. If the pulp cavity is exposed,the tooth will require treatment. These teeth arepainful (although very few animals show obviousdental pain), and an exposed pulp will result ininflammation and infection around the tooth root.

Tips for extracting cats’ teeth Incisors, canines and the ‘first’ upper premolar

are single-rooted teeth. The upper fourth premolarhas 3 roots and all other teeth have 2 roots.Multirooted teeth must be sectioned into individualroots before extracting the tooth. The furcation (areabetween the two roots) lies below the main cusp, sosectioning must be performed from the furcationupwards to ensure correct division of the tooth.

Pre-extraction radiographs are useful to identifyabnormalities affecting the tooth roots or the extentof any pathology.

Part of the crown should be removed to enableplacement of the elevators in the correct positionbetween the bone and tooth in the periodontal ligament space.

Canine teeth should always be extracted surgically using a buccal flap approach.

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 catsExtraction 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 ofhypercementosis and require a gentle tug after the root has been loosened with elevators

Small round friction grip burs, no. 1or 2 – used to section teeth. The smallbur allows an adequate groove to becreated for placement of instrumentswithout obliterating too much surrounding bone or tooth substance

dental tools

AS SHOWN IN the WellCat Health Chart on pages 6 and 7, the recommendation is that routine urinalysisis performed in cats aged 7 years and upwards, andthat routine haematology and biochemistry are performed in cats from age 11 upwards.

Why this recommendation?Not only will the initial tests provide individual baselinemeasurements that will be invaluable as a comparisonshould the cat later present for illness, but this alsoallows monitoring for trends in changes. It is importantnot to evaluate each set of results in isolation, butalways to compare them with all previous results tolook for parameters that may be within the normalrange, but gradually increasing or decreasing. This willallow much earlier detection of important changes. Given

In-house versus external laboratoryAlthough in-house analysers are useful for providing immediate results, they have a number of limitations andrequirements that must be borne in mind:

For many parameters, in-house analysers are not as accurate as external laboratoriesIt is essential that quality control samples are run dailyConsideration should be given to running some samplesin parallel with an external laboratoryIn addition to improved accuracy and quality controloffered by external laboratories, there is also assistanceavailable with interpretation of results. This is key todeciding how to act upon those results

BiochemistryVarious in-house biochemical analysers are available andthese vary in performance. In general, many are acceptablefor evaluating urea, creatinine, total protein and liverenzymes, but are unreliable for electrolytes, albumin andglobulin. In-house total thyroxine (T4) tests should also beinterpreted with caution as they do not appear to be reliable.

HaematologyAgain, different in-house haematology analysers are available, but in general they are reliable for determiningpacked cell volume (PCV)/haematocrit (HCT), red blood cell(RBC) count and haemoglobin, but are not reliable for providing information to determine whether an anaemia isregenerative or non-regenerative, the nature of a leukocytosis

interpreting abnormalitiesInevitably 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.

furtherinfoat www.fabvets.org FAB Veterinary Factsheet

Dentistry

FAB Clinical ProtocolManaging the cat with

chronic gingivostomatitis

An alternative choice of equipment isthe EX5 – standard, EX5S – serrated forcanine teeth, EX5H – modified with anotch for ankylosed teeth, and theSuperslim 100C – for retained root tips(all available from www.drshipp.com)

Pre-anaestheticblood testsIt is controversial whetherpre-anaesthetic bloodtests are warranted in clinically healthy patientswith no abnormalities onphysical examination.However, given the cat’simmense ability to disguiseearly signs of disease,these tests are undoubtedly useful and ina few apparently clinicallywell cats they will provelifesaving – for example,the cat with subclinicalrenal disease. Furthermore,they again provide a baseline value. For example, in a cat that develops problems duringanaesthesia or surgery, it can be difficult to interpret laboratory abnormalities without knowingif 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.

WellCat 25

Laboratory teststhat cats are such ‘masters of disguise’ andoften do not show overtclinical signs until in theadvanced stages of illness,routine monitoring canmake all the difference –picking up changes beforesigns of illness occur andallowing much more successful management of many disorders.

The WellCatlog asks owners to tick a box to indicatewhen 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 aidunderstanding of feline life stage changes.

UrinalysisUrinalysis is a very underused diagnostic test. Routineurinalysis 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 aredetected. The WellCatlog asks owners to record theircat’s urine specific gravity at each health check. Again,this basic information will allow trends to be analysedthroughout 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 smearexamination by an experienced haematologist will significantly increase the information obtained; it will alsohelp to identify errors in the analyser results, such as thepresence of interfering factors (eg, haemolysis).

Influence of ageYoung cats

Haematology – younger animals are more likely to havea stress neutrophilia and a lymphocytosis.Biochemistry – alkaline phosphatase (ALP) may beincreased 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 duringgrowth.

Older catsIn general as animals age cells becomes less able to tolerate any damage, which may predispose to dehydrationand tissue anoxia. Immune system function decreases predisposing to infectious and neoplastic disease.

Biochemistry – a reduction in functional renal mass occurswith age and older cats can be expected to have suboptimally concentrated urine ± mild elevations in urea± creatinine. Creatinine can be normal if there is reducedmuscle mass. Mild elevations in urea can also be causedby a recent meal or gastrointestinal bleeding. Samplesshould be taken following a minimum 8 hours’ fast, and should always be interpreted in conjunction with urinalysis.

Influence of medicationsDrugs 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 aresult of steroid hepatopathy; but bear in mind there isno steroid-induced isoenzyme of ALP in cats. A stressleukogram can also resultFurosemide results in a reduction in sodium, potassium,chloride and calcium levels and an elevation in urea andtotal proteinOxyglobin leads to changes seen with haemolysisincluding increased creatinine, total protein and bilirubin,and reduced ALP. On haematology, oxyglobin will bemeasured together with total haemoglobin (this is ameasure of the total oxygen-carrying capacity of blood,PCV/HCT will not reflect oxygen-carrying capacity)Methimazole can induce a leukopenia and/or thrombocytopeniaAnaesthetic agents and sedatives may result in a reductionin PCV of up to around 20%. Total protein and white bloodcell counts will also reduce. This is important to rememberwhen a cat requires sedation for blood sampling

Influence of breedWhile proof of specific breed-related laboratory abnormalities islacking, there are some known or suspected breed anomalies:

Birman cats often appear to have mildy elevated renalparameters that generally do not result in any clinicallysignificant deteriorationAbyssinian and Somali cats are often found to be mildlyanaemic. This is likely to be the result of an inherited redblood cell osmotic fragility, and/or pyruvate kinase defi-ciency (www.fabcats.org/owners/pk_deficiency/info.html)

See also page 16.

Complete haematology – differential white blood cellcount, red blood cell indices and evaluation of a bloodsmear including platelet numbers

Biochemistry – urea, creatinine, glucose, total protein,albumin, globulin, alanine aminotranferase (ALT), alkalinephosphatase (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 beroutinely performed in all diabetic patients, those with urinespecific gravities below 1·030, where an inflammatory sediment is identified, and if urine protein:creatinine ratio isincreased (>0·4)

Additional tests – serum total T4 should be performed insenior and older cats, or those with compatible clinicalsigns and/or a palpable goitre

routine ‘profile’

Hyperglycaemia – a stressresponse?Blood glucose should always beassessed using a glucometer ifinsufficient blood is obtained foran oxalate fluoride blood tube.Most human glucometers willunderestimate blood glucose byapproximately 1 to 1·5 mmol/litre.Recently a veterinary glucometerhas become available(AlphaTRAK, Abbott) that is moreaccurate in animals and onlyrequires 0·3 μl of blood.

Stress hyperglycaemia is common in cats, although is|minimised by appropriate handling and examination (seepage 14). When identified, however, hyperglycaemia mustnot simply be assumed to havebeen caused by stress andignored, as early diabetes will bemissed. Hyperglycaemia shouldtherefore always be followed upby assessment for glucosuria ona home glucose sample and/orserum fructosamine measure-ment at an external laboratory.

Be aware that if a blood sampleis taken under α2-agonist sedation, this can also result inhyperglycaemia.

furtherinfoat www.fabcats.org

FAB Owner Info SheetPyruvate kinase (PK) deficiency

26 WellCat

AntibioticsConfine antibiotic use to appropriate clinical

conditions. Before administering antibiotics alwaysconsider whether they are actually indicated. Thismeans first obtaining a definitive diagnosis whereverpossible, to identify conditions where antibiotic therapyis not appropriate. In many cases where antibiotics areadministered, bacterial infection may not actually bepresent (eg, idiopathic cystitis).

Where appropriate consider alternative therapies before initiating antibiotics. For example, many cases where antibiotics are initiatedmay respond just as well to supportive care alone,involving correction of any fluid and electrolyteimbalances 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 belargely based on ease of administration, which clearlyis 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 successfullyadminister long courses of antibiotics with no compliance problems. However, it is important not tobase antibiotic choice soley on this, but also to consider the other vital aspects detailed below. Long-acting cefovecin should be reserved for cats that definitely need at least 2 weeks of antibiotics, andthose where a 3rd generation cephalosporin is indicated. Care must be taken not to use such a drugindiscriminantly for minor infections where a shortercourse or a narrower spectrum antibiotic would bemore appropriate. Inappropriate use of such antibioticsresults in an increased risk of multiresistant bacteriaand adverse drug reactions.

Always try to choose an appropriate antibioticbased on bacterial culture and sensitivity results,and the location of the infection. If empirical antibiotics need to be used, the choice of drug shouldbe 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 theaffected organ at an appropriate concentration.

Use narrow spectrum antibiotics where possible as a first line treatment.

Antibiotics that are required to treat relativelyresistant bacteria in both human and veterinarymedicine should be avoided for routine use where possible. Antibiotics such as fluoroquinolonesand 2nd/3rd generation cephalosporins should bereserved for resistant organisms.

Consider the duration of antibiotic treatmentrequired. Treat for the shortest effective periodpossible in order to minimise therapeutic exposureto 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, neurotoxicitywith metronidazole, oesophagitis with doxycyclineand hypersensitivity reactions with cephalosporins.

Ensure owners are adequately educated whenantibiotics are prescribed. Clear written directionsshould be provided in addition to verbal instructionsand a demonstration of how to administer the prescribed medication. Clients should be advised tocomplete the entire course of medication even ifsigns of illness have resolved. They should bewarned of potential adverse reactions, and advisedwhat to do if any such reactions occur.

Do not depend on antibiotics for prophylaxis.Antibiotics should not be used as a prophylacticmeasure in place of good management andhygiene (eg, sterile surgical procedures).

Where possible, address known risk factors forbacterial infections by treating underlying disease,or using appropriate hygiene precautions to preventbacterial infection. Common risk factors for bacterialinfections in cats include urinary catheterisation, presence of dilute urine, dental disease, diabetesmellitus, use of intravenous catheters, immunosuppressive drugs, and environmental factorssuch as poor hygiene, stress and poor housing.

ANTIBIOTICS AND GLUCOCORTICOIDS are among the most widely used drugs inveterinary medicine. They are also among the most widely misused. With increasingconcerns of multiresistant bacteria, appropriate antibiotics usage becomes even morevital. Equally, it is important to take into consideration a number of factors for eachfeline patient before corticosteroids are prescribed.

Rational treatment protocols

CorticosteroidsDuration of actionCortisone and hydrocortisone are short-actingpreparations.Prednisolone and methylprednisone are intermediate acting.Dexamethasone and betamethasone are longacting.Only prednisolone and methylprednisone areappropriate for alternate-day therapy and

Complete all diagnostics wherever possible. Otherwise the treatment can mask signs of underlying disease andcomplicate the specific diagnosis and therapy. This is particularly important with lymphoma, since corticosteroidtreatment may induce a multidrug resistance, meaning theneoplasm 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

before starting steroids

A protocol for the rationaluse of non-steroidal anti-inflammatory drugs in catsis being developed by FAB,and will be available onwww.fabvets.org

NSAIDs

EVERYONE UNDERSTANDS THE CONCEPT ofinsuring against unexpected expense but somepeople are bewildered by the huge array of products available to insure their pets. Hardly surprising – choosing from around 225 productscan be daunting! However, the overall percentageof pet owners choosing to insure their pets isgrowing and, once it has been explained properly,most people do choose to insure their pets againstthe unexpected costs of veterinary fees and drugsresulting from treatment for illness or injury.

As with all financial products and services, the sale of pet insurance iscarefully regulated and many veterinarypractices have chosen not to take onthe commitment of selling policies.However, most veterinary practicesbelieve strongly in the importance of petinsurance to their clients even thoughthere still appears to be widespreadconfusion about the role of the practicein recommending the concept of petinsurance.

A client’s first visit to the practice is the ideal timeto 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 incomestream from insured clients and giving the practicethe opportunity for earlier diagnosis, treatment andcure. Statistics show that insured customers are alsomore likely to undertake preventive care as they willbe more aware of services offered and more likely to purchase food and other pet products from thepractice.

No. Uninsured owners are less likely to visit thevet. Petplan research shows that almost twice thenumber of insured clients visited the vet, over theprevious 12 months, than those without insurance.Human nature will see people who are unsure oftheir finances hanging back to see whether or nota condition will worsen before visiting the vet, whileinsured clients will be confident in going to the vetassured that the best treatment will be availablewhenever they need it. If the client isn’t insured, asimple suggestion that it is in the animal’s bestinterest for the client to consider insuring againstunexpected veterinary costs is all that is requiredto embed the concept and value of pet insuranceas part of the practice’s customer offering.

Working closely with practices, Petplan’s analysisof the market has shown that increasing the numberof insured clients has a direct effect on the businessbottom line and can play an important role in clientretention. At a time when active client numbers continueto shrink, in most practices this invisible benefit can beof considerable importance.

WellCat 27

Well insured?

Source: Petplan – data on file

generally are the only glucocorticoids that shouldbe used for long-term administration.

Duration of action is also greatly influenced by theformulation used:

Sodium phosphate, hemisuccinate and sodiumsuccinate esters are soluble, rapidly acting(minutes to hours) preparations. Acetate, diacetate, isonicotinate and tebutateesters are moderately insoluble, with a durationof days to a few weeks. Pivalate, diproprionate, hexacetate and acetonide esters are the least soluble, with aduration of a few to several weeks.

PotencyUnderstanding differences in glucocorticoid potenciesis 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 ofprednisone is 4, while that of dexamethasone is 30.

Route of administrationFor some diseases, consider whether an alternativeroute of administration would be preferable; for example,inhalational therapy for asthma and ophthalmic therapyfor uveitis, rather than systemic therapy.

Side effectsThere are many potential side effects associated with glucocorticoids including iatrogenic hyperadrenocorticism, diabetes mellitus, polyuria/polydipsia, lethargy, hepatopathy, predisposition togastrointestinal ulcers, muscle catabolism and atrophy,inhibition of bone growth, reduction in collagen synthesis (and thereby rate of wound healing), thinningof skin, capillary fragility (resulting in ease of bruising),alopecia, exacerbation of clinical or latent infectiousdiseases, and possibly predisposition to hypertensionand exacerbation of pre-existing heart disease.

Remember that locally applied (ophthalmic, topical,intralesional) glucocorticoids are also absorbedsystemically and therefore are associated with similar systemic effects.

efficacy to be assessed and help decide when the drug doseshould 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 ispredisposed to any potential side effects such as diabetesmellitus.

Select the most appropriate glucocorticoid preparation. It isimportant 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 onthe hypothalamic–pituitary–adrenal axis.

PracticerecommendationsIn short, there is no restriction on anyone in the practice recommendingthe benefits of pet insurance to aclient – it is only when the practicemakes specific recommendations,suggesting one brand before another,that training may be required.

28 WellCat

Food and water intakeTips for increasing a cat’s water intake

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 themeat in ice cube trays. An ice cube can be put inthe water bowl each day to add a ‘meaty’ flavourto 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 typeof container that the water is in (glass, metal orceramic rather than plastic, which retains odours),as well as the shape of the container (large widecontainer, glass, mug, etc).

It is useful to try different containers in differentlocations in the house to identify an individual cat’spreference.

Multiple water bowls should be provided, located away from food and litter areas.

Cats should be able to drink alone without therisk of another cat coming up behind them.

Tips for changing a cat’s dietChanging 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 importantfirst to ensure that the cat is at home, feeling betterand 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 bychanging its feeding schedule to meal feeding by onlyleaving food out for 1 hour at each feeding time.

Start to offer the new food in the cat’s usualfeeding bowl next to the old diet, using anotherbowl for its old food. If the cat doesn’t eat the newdiet after an hour, remove it until the next feeding.At the next feeding, repeat the process, alwaysproviding 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 thechange is complete. Using this strategy, thechange 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’sfavourite food, or meat or fish juices, can be mixedwith the new food initially to make it more appealing.

Feed your pet in a quiet environment where itwon’t be distracted.

Monitor the cat’s weight – no more than 10%bodyweight should be lost in the transition fromone diet to another.

Be aware of the risk of hepatic lipidosis if weightloss occurs too rapidly.

THERE ARE TIMES when a client will need toincrease their cat’s water intake or change its diet,for a variety of therapeutic reasons. The cat mayhave idiopathic cystitis and the aim is to encourageit to produce a more dilute urine, or it may have renalinsufficiency and we want to help prevent dehydration. It may be that a prescription diet isneeded. Whatever the case, clients may initially thinkthat this is an impossible request and it is importantfor maximising compliance that they can be givensome practical advice on how to achieve this.

coaxing the inappetent cat

Some inappetent cats will respond well to hand feeding, particularly whenthey are feeling relaxed such as when they are in a favourite resting place, orare being stroked. However, owners should resist the temptation to keeppushing food in front of the cat’s nose if it isn’t interested as this can result ina food aversion

Cats can get themselves into a vicious circle of feeling ill, not eating andbecoming depressed. They can respond well to some tender loving care andencouragement to eat from their owners. Finding things that are temptingand getting a cat started on eating again can make all the difference to itsrecovery. 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 nothave to compete for food or a resting placeIncrease the appeal of the food by adding strong flavours like fishWarm the food to body temperature to improve its aromaGently smear a small amount of food on the cat’s paws or face – thisusually stimulates a licking response that may then get the cat startedon eating againTry particularly tasy foods such as cooked fish or chicken, or commercial supplementary foods. Alternatively you may prescribe the cat with apalatable, high calorie food (eg, Hill’s a/d)Avoid feeding human foods that contain onion or garlic, as these cancause toxic damage to cats’ red blood cells, with resultant anaemia.Examples include some baby foods, soups, flavoured meats and foodflavourings

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 worldof difference to the owners.

Performing euthanasiaAlways handle the cat gently and calmly and try tomake it feel as relaxed as possible. Consider placing an intravenous catheter in advance. This willallow 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 usefulwhere heavy sedation is requiredbut it should be avoided in orientaltype breeds as it can have anadverse effect, making themhyperactive and uncontrollablerather than sedating them. Notethis can also occur unpredictably in any breed of cat, includingdomestic shorthairs/longhairs.

In cases where intravenous accessis very difficult, consideration canbe given to intrarenal, intrahepatic or intraperitonealinjection. If the owner is present always explain whatyou are doing and why.

Before performing the euthanasia allow time for thecat to relax where possible. Some owners like tospend some time alone with their cat; others, oncethe decision has been made, just want it carried outimmediately. Offer the owner both of these options.

WellCat 29

SADLY EUTHANASIA IS a very common and necessary procedure in day-to-day veterinarypractice. It is sometimes easy to forget what a bigresponsibility it is and that, as far as the client isconcerned, it constitutes the single most important and distressing time that they ever taketheir pet to the vet.

While the purpose of euthanasia is to alleviate thecat’s suffering, it is vital to remain sensitive to thebond between owner and cat. Most owners willremember always every detail of their cat’seuthanasia and the vet who euthanased their cat.A good experience can bond the client to thepractice for life; a bad experience can lead to muchdistress, complaints and, in some cases, clientsmoving practices. It is clearly extremely worthwhileto take the time and effort to make the experienceas calm, compassionate and gentle as possible.The vet’s ability to communicate with the owner andhelp them through this difficult time is key.

Planning for euthanasiaWhen euthanasia is being planned in advance,encourage owners to discuss their expectationsand talk through what will be done and how (see box). Consider when the euthanasia will beperformed: if it is a scheduled appointment, try toarrange a time when you are less likely to berushed 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 aspecial blanket or basket that they would like thecat to be placed in.

These various discussions could be handled by awell-trained veterinary nurse and need not necessarilyinvolve the vet. It is certainly worth investing in sendingone of the nurses on a pet bereaverement counselling

Pros and cons of euthanasia at home versus inthe clinicWhether the owner wants to be with their cat atthe time of euthanasiaIf so, what their role will be. For example, willthey want and be able to hold their cat, orwould they rather a nurse held the cat whilethey stroked its head?What the procedure will involve (eg, prior sedation, catheterisation, what will be done ifintravenous access cannot be obtained, etc)How the cat may react (eg, the possibility of agonal breathing, and urination/defecationfollowing the procedure)Whether the owner will want to take the cat’s bodyhome, or opt for normal or individual cremationIf appropriate, whether they would like a postmortem examination. Discuss the benefits, including whether it may help gather valuable information that will benefit other cats in the future

what to discuss

Euthanasia – best practice

Don’t leave a cat suffering while waiting to beeuthanased (make it as comfortable and pain-freeas possible right up to the point of euthanasia)Don’t be impatient and rushedDon’t be unsympatheticDon’t ignore the owner’s wishesDon’t attempt intracardiac injectionDon’t use sedatives that will reduce blood pressure to the extent that it can make finding avein more difficult (eg, medetomidine)

Some don’ts

30 WellCat

Pet Bereavement SupportService

Anyone who has experienced the loss of a much-loved pet will understand how

devastating it can be. Sometimes it can bereally helpful to talk to someone who

understands. The Pet Bereavement SupportService (PBSS), run by The Blue Cross andthe Society for Companion Animal Studies

(SCAS), offers telephone and e-mail supportfor 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 ofbereaved pet owners since its inception in

1994, also offers practical information, supportand training on pet bereavement for veterinary

practices and others.

Telephone: 0800 096 6606 (lines areopen 8.30 am to 8.30 pm every day) e-mail: pbssmail@bluecross.org.uk

All calls and e-mails are free and confidential and are answered by trained

volunteers throughout the UK.

Sleeping cat

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 thatyou care and that something positive will result from the loss of their cat.

Make sure the cat is as relaxed as possible and,where appropriate (depending on how sick the catis), had some ‘enjoyment’ before the euthanasia(eg, a cuddle, feeding of treats, etc) that you arealso able to relay to the client. Ensure that adequateanalgesia for any painful conditions is given up untilthe point of euthanasia.

If the owner has arranged to collect the cat’s body,arrange the cat carefully in its basket or a coffinbox in clean sheets/towel with incontinence pads,before rigor mortis sets in.

If the owner wants to hold the cat while euthanasiais performed, then consider using an extension setattached to the catheter so that you can inject thecat from a distance. This often works very well,with the owner barely aware that you are doinganything as the cat appears to drift off to sleep intheir arms. Give the owner a towel or incontinencesheet to hold the cat in and warn them that it mayurinate and defecate during the procedure.

Have a bed ready to lay the cat on following theeuthanasia, a clean towel to cover the cat andincontinence sheets in case urination occurs. Berespectful of the body, and arrange the cat so itlooks as peaceful as possible.

After the procedureSome owners may want to leave straightaway. Ifpossible, arrange for them to leave via a back doorso they don’t have to exit through a busy waitingroom. Some owners may want to stay and talk fora while. Others may want to be left alone with theircat’s body – ensure that you don’t rush them ifthat is the case.

Send a sympathy card a couple of days later –clients usually really appreciate this gesture and itdemonstrates that you have a genuine care fortheir cat.

Euthanasia in the owner’s absenceSometimes it may be necessary to euthanase acat in the owner’s absence – perhaps because theowner is away, is unable to get to the practice intime if their cat has deteriorated while hospitalised,or has chosen not to be there at the time. It iscomforting to owners if they aren’t present toknow that their cat was as comfortable and happyas possible when euthanasia occurred.

Back in those early days the profession didn’tknow what caused cat ’flu, and feline hyperthyroidism, immunodeficiency andleukaemia were unknown words. A cat did noteven have the status of a small lap dog andsmall animal medicine (let alone feline medicine)

was something for vets who couldn’t hack the real thing! Asking vets toconsider minimising stress for cats coming into the practice would surelyhave been met with complete incredulity. How things have changed –now cats are a vital part of practice and FAB’s work to provide informationon 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 thebroad spectrum of cat keeping. The charity now occupies a pivotal position infeline welfare, supporting and – perhaps more importantly – helping to bridgethe 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 forthis 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 differentlocations across Europe, has become a hugely popular event and theJournal of Feline Medicine and Surgery well established. Indeed, in 2009,ESFM will add an extra dimension to the journalwith 6 extra issues. Called JFMS Clinical Practice,these will carry colour reviews on all aspects of felinepractice and will be designed to be highly practicaland applicable to day-to-day practice.

Over 350 practices in the UK and many abroad arenow FAB Practice Members and receive a range ofbenefits. If you want to keep up to date with thingsfeline then there is no better way – see overleaf formore information.

WellCat 31

50 years of helping cats

This year the Feline Advisory Bureau celebrates 50 years of making cats’ lives better.

32 WellCat

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 JFMSClinical PracticeQuarterly CatCare journal10 x £20 educational vouchers redeemable for any practice member (veterinary surgeons and nurses) to attend FAB and ESFM education days and conferencesComplete set of FAB information sheets including new and updated sheets as theyare producedCertificate of membership for waiting roomCat Group policy statements and discussion documents, including new sheets asthey are producedListing 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 bookletsFree Cat Friendly Practice literature dispenser plus some leaflets

Additional Branch Practice£75 UK £120/€171 Overseas (prices for 2008 membership)Members receive:

Certificate of membership for waiting roomListing 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

Practice membership Application formPlease 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 PAYBy Cheque: please make cheques payable to ‘FAB Ltd’ By Debit/Credit Card: please complete the section below. We acceptVISA/MASTERCARD/SWITCH/DELTA (delete as appropriate) Card number:

Valid from: ............. Valid to: ............. Security code: ............. Issue number (Switch only): .............

JFMS Clinical Practice– coming in 2009

WellCat for lifeSUPPORTED BY

Registered Charity no: 298348

Vicki AdamsSarah CaneyMartha CannonJulie CoryCharlotte DyeYaiza ForcadaDarren Foster (Australia)Pru Galloway (New Zealand)Tim Gruffydd-JonesDanièlle Gunn-MooreAndrea HarveyAngie Hibbert

Mark JacksonMichiel Kraijer (Netherlands)Amy Mackay (USA)Nicki ReedSuzanne RuddAnita SchwartzKerry SimpsonAndy SparkesSéverine TaskerSamantha TaylorMaud van de Stadt-GouldSheila Wills

Jon BowenRobert Falconer-Taylor Vicky HallsSarah HeathKim HorsfordJenna KiddieDaniel MillsPeter NevilleFrancesca RiccominiRoger Tabor

The Governing Council of the Cat Fancy