Designing a medical care program for cats of all ages (Proceedings)
With a program like this in place, I believe you can help these cats achieve a longer, higher quality of life.
My perspective – I am an internist in private practice. Because I am not associated with a university or large referral hospital, I have a better understanding of "real life" in a veterinary practice. My job as a veterinarian is to make medical care recommendations based on what the patient needs. The following is my opinion regarding what I believe to be an ideal health care program for cats of all ages, even before they develop the chronic illnesses that I typically deal with. With a program like this in place, I believe you can help these cats achieve a longer, higher-quality of life. As you develop or modify a comprehensive feline health care program for your practice, be sure to include all your employees in the implementation of the plan. Make it easy, make it clear and most of all, be consistent with the program.
Kittens – Birth to one year of age
You will see the new kitten often during this first year of life. Each visit is an opportunity to educate the client on the type of care that you believe is best for that kitten. Remember, the client is at your hospital wanting your advice.
"What does my kitten need?"
Comprehensive health care program for kittens:
- Routine wellness examinations
- Viral testing (FeLV/FIV) – once
- Parasite exam
- Heartworm testing/preventative
- Vaccinations based on individual kitten's need/environment
- Baseline bloodwork and urine tests (usually preanesthetic evaluation)
- ECG and blood pressure prior to anesthesia
- Spay/neuter surgery at appropriate age
Focus on education of client regarding pet's needs – Feline behavior, dental care, dietary counseling/exercise, and individualized parasite control programs. Handouts are helpful to the client. Your recommendations should be echoed by all employees.
Adult cats (healthy) – One to seven years of age
This cat will visit your office twice a year. Since the pet is apparently healthy, the client may not be aware of health risks and the importance of detecting disease at an early stage (before signs of illness).
Comprehensive health care program for adult cats (healthy):
- Obtain an updated medical & behavioral history at each visit
- Routine wellness examinations – twice a year
- Viral testing (new patients)
- Parasite exam - yearly
- Heartworm testing/preventative – yearly
- Review vaccinations needs
- Bloodwork and urine tests – yearly or prior to any procedure requiring anesthesia
- Blood pressure measurement – yearly or prior to any procedure requiring
- Anesthesia
- ECG – yearly or prior to any procedure requiring anesthesia
- Dental cleaning and polishing when needed
- Focus on education of client regarding pet's needs
Senior cats (healthy) – Seven years of age plus
This cat will visit your office twice a year. The client is probably more aware of health risks as the pet ages, but may be unsure what those risks are and what age is considered "senior".
Comprehensive health care program for senior cats (healthy)
- Obtain an updated medical & behavioral history at each visit
- Routine wellness examinations – twice a year
- Viral testing (new patients)
- Parasite exam - yearly
- Heartworm testing/preventative – yearly
- Review vaccinations needs
- Bloodwork and urine tests – every 6 months and prior to any procedure requiring anesthesia
- Blood pressure measurement – every 6 months and prior to any procedure requiring anesthesia
- ECG – yearly and prior to any procedure requiring anesthesia
- Dental cleaning and polishing when needed
- Focus on education of client regarding pet's needs
Adult and senior cats with clinical signs of disease
This cat will visit your office more often because the client is aware that there is a problem. You need to clearly educate the client about the type of medical care the pet needs to correct or delay the progression of disease while improving or maintaining residual function. Clients desire a good quality of life for their cats. Give the clients the information they seek so they can make informed decisions regarding their cats' medical care. Your staff should also be educated about the medical care you are recommending. Be consistent.
Comprehensive health care program for cats with clinical signs of disease:
- Obtain an updated medical & behavioral history at each visit
- Routine wellness examinations – every 3-6 months, or more often depending on the cat's condition
- Viral testing– retest cats with chronic illnesses/non-responders
- Parasite exam – yearly
- Heartworm testing/preventative - yearly
- Vaccinations – not a priority at this time but review risk factors.
- Bloodwork and urine tests – as indicated by the cat's condition but at least every 3-6 months.
- Blood pressure measurement – as needed but at least every 6 months.
- ECG – as needed but at least every 6 months.
- Dental cleaning and polishing when needed
- Focus on education of client regarding pet's needs
End of Life Issues
What is quality of life? Have everyone in the cat's family determine what 5 things make this cat what s/he is. This is a list that only they can make. Make this list prior to any major illness or chronic disease if possible. When the cat has lost 3 of the 5 things, then the family will know the cat's quality of life is not what it should be. This may help them make/ face some difficult decisions.
Euthanasia – Be prepared. Have your staff trained so that these events run smoothly. This is a very emotional time, and you need to be prepared and organized.
Dealing with grief – Grief packet with handouts/references/websites; Discussion groups
Sympathy card or other expression of grief/ understanding sent to the cat's family.
Blood Pressure Measurement
High blood pressure is a common complication of many diseases that we recognize in our feline patients. The time to diagnose high blood pressure is before damage is done. Retinal hemorrhages and detachment can be avoided. I recommend that Doppler ultrasonic blood pressure measurements begin in all patients at an early age as part of their yearly wellness exam. That helps the veterinarian establish a baseline for each individual pet. Once a pet has been diagnosed with a disease that can cause high blood pressure (chronic kidney disease, hyperthyroidism, obesity), blood pressure measurements should occur at least every 3-6 months or sooner if any concerns arise. High blood pressure can also be a silent killer. Your clients are well educated about high blood pressure, so it is easy for them to understand the importance of blood pressure control in their cats.
Normal blood pressure measurement: 145 mmHg or less (systolic reading)
**Follow up Plan: Physical exam including fundic exam, Blood pressure measurement every 3-6 months; Recheck BP measurement 1-2 weeks after starting drug therapy.
Weight management
The fat feline is a problem all practitioners face. Clients often believe that a fat cat is a healthy and happy cat. They are more likely to bring the cat in for an exam due to poor appetite rather than overeating and obesity concerns. It is important to integrate weight management into your medical care program. The goal is to control the eating habits, diet and exercise of the cat before obesity develops (good habits, good health) and to regain control once a weight problem has developed.
Dental health
Bacteria associated with dental tartar as well as dental pain due to diseased teeth and gums contribute to the overall decline of all patients. This is equally true in our senior patients and those with chronic diseases (kidney disease, diabetes mellitus, heart disease, etc). Patients of all ages and patients with chronic, stable disease should receive regular dental cleanings and extractions to make sure good dental health is maintained. With good dental health, secondary infections are less likely as well as decreased food intake due to dental pain.
**Follow up Plan: Oral exam at every physical exam; Dental prophy and extractions as indicated.
Pain management
Pain is pain, no matter the age of the patient. Pain, whether acute or chronic, should be controlled as soon as possible. Special consideration should be given to any underlying conditions or drug interactions. Some causes of chronic pain include degenerative joint disease, inflammatory diseases, dental disease, and neoplasia. Acute pain can be caused by trauma, surgery, neoplasia, and diseases such as pancreatitis, urinary tract disease, and gastrointestinal disorders. There are a wide variety of oral and injectable pain medications available for use in the feline patient. In general, nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in cats with renal compromise or preexisting gastrointestinal ulceration. Nutraceutical supplements may also help alleviate some forms of pain (glucosamine, chondroitin sulfate, omega-3 fatty acids).
**Follow up Plan: Make sure pain is being adequately controlled. Telephone recalls – How is pet? Recheck exams may need to occur more frequently. Consider weight management plan for overweight cats.
Behavioral health care
Probably the most common behavior concerns in cats are inappropriate urination and defecation. In our older cats, these behaviors are likely related to underlying disease, arthritis, pain, decreased mobility or cognitive dysfunction. A comprehensive history as well as complete physical exam and diagnostic work-up will help identify these underlying conditions. Treatment should first be aimed at the health problems. Behavior modification may later be needed.
Another behavior concern in senior cats is change in attitude, usually described as more aggressive or "cranky". Underlying disease or pain should also be considered as possible causes for these attitude changes. Hyperthyroid cats will often show behavior changes due to their disease (increased irritability, increased affection, etc).
Clients will comment that their cats are "slowing down" in their old age. While this is possible, it is prudent to make sure this lethargy is not due to an underlying disease such as cardiac disease, hypertension, or other metabolic concern.
Cognitive dysfunction is more difficult to diagnose. In the absence of any physical causes, the one or more of the following behavioral changes may be observed – decreased reaction to stimuli, confusion, disorientation, decreased interaction with the client, increased irritability, slowness in obeying commands, alteration in sleep patterns, decreased responsiveness to sensory input, increased vocalization, and problems performing learned behaviors.
**Follow up Plan: Once a behavioral issue is identified, address the problem with environmental changes and/or drug therapy. Telephone recalls – how is pet? Make sure the problem is being addressed. Consider changes to your recommendations as needed.
To provide the best medical care for our feline patients:
- Have a clearly defined health care program in place covering all life stages.
- Educate employees and your clients about the recommended health care program.
- Be consistent.
- Identify and define disease at earliest possible stage.
- Educate the client about the disease.
- Develop clear follow up plan with the client.
- Implement follow up plan. Use recall/reminder system.
Websites of interest:
Selected Readings
AAFP/AFM Panel Report on Feline Senior Care, J Feline Med Surg, 7: 3-32, 2005.
Beale BS: Use of nutraceuticals and chondroprotectants in osteoarthritic dogs and cats. Vet Clin North Am 34:271-289, 2004.
Brown S, Atkins C, Bagley R, et al: Guidelines for the identification, evaluation and management of systemic hypertension in dogs and cats. J Vet Intern Med 21(3):542-58, 2007.
Burkholder WJ, Bauer JE: Foods and techniques for managing obesity in companion animals. J Am Vet Med Assoc 212:658-662, 1998.
DeBowes LJ, Harvey CE: Disorders of cats: the oral cavity and dental disease. Geriatrics and Gerontology of the Dog and Cat. Philadelphia, W.B. Saunders, 1995, pp 128-134.
Elliott J, Barber PJ, Syme HM, et al: Feline hypertension: clinical findings and response to antihypertensive treatment in 30 cases. J Small Anim Pract 42:122-129, 2001.
Holmstrom SE: Geriatric veterinary dentistry: medical and client relations and challenges. Vet Clin North Am 35:699-712, 2005.
Hypertension Consensus Panel, American College of Veterinary Internal Medicine (report), in Proceedings. 20th Annual Vet Med Forum, 2002.
Laflamme DP: Nutrition for aging cats and dogs and the importance of body condition. Vet Clin North Am 35:713-742, 2005.
Landsberg G, Ruehl W: Geriatric behavioral problems. Vet Clin North Am 27:1537-1559, 1997.
Sansom J, Rogers K, Wood JLN, et al: Blood pressure assessment in healthy cats and cats with hypertensive retinopathy. Am J Vet Res 65:245-252, 2004.
Scarlett JM, Donaghue S: Associations between body condition and disease in cats. J Am Vet Med Assoc 212:1725-1731,1998.
