WellCat for life

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