March 2023, The Feline Purrspective

Going to the vet can be an otherworldly experience for a cat!

Going to the vet can be like a scene from a science fiction movie for your cat. He becomes anxious the moment the “spaceship” (carrier) comes out. He boards his spaceship and then launches into the unknown. When his craft lands on the alien surface ( the vet clinic), he is met by aliens who make strange noises and poke and prod him with exotic instruments.

You have been working to make this experience not so frightening – you have carrier trained your cat, introduced him to the car, and practiced cat friendly handling with him. While training sets the stage for a good vet visit, sometimes a little medication can help a cat relax at the vet, reducing his anxiety just enough to make the visit a good one.

My youngest cat, Gus, was trapped on the streets of Old Colorado City and came to live at CatTails Feline Health Center for about 6 months before I took him home. You would think that returning to a place he is familiar with would not be traumatic. However, when we returned for an exam, his heart rate was a whopping 230 bpm in spite of his training and my being with him. Gus now receives a dose of gabapentin before vet visits to reduce his anxiety and his heart rates are lower, 190-200 bpm.

Pre-Appointment medication can help a cat relax at the vet

Two of the more common drugs used to reduce cats’ anxiety at the veterinary clinic are gabapentin and trazadone.

gabapentin

developed as an anti-convulsant
has anti-anxiety properties – reduces the release of excitatory neurotransmitters
is a pain reliever

The typical dose is 100 mg given 1.5 – 2 hours prior to your cat’s vet visit. Frequently, a dose is given the night before. Doses can vary for individual cats – some cats may do well with a 50 mg dose while others may need 150 mg

Gabapentin is available in capsules; it can also be compounded in small tablets or made into a liquid.

capsules: The capsule is opened and the powder is mixed in a small amount of tuna fish or canned cat food. Gabapentin is bitter and some cats may not eat it in food. In these cases, it may be better to give the capsule directly to the cat.
liquid: The liquid may result in foaming at the mouth.
tablets: Gabapentin can also be compounded into flavored small tablets.

Your cat may be a little sleepy or wobbly after taking gabapentin. You may want to watch kitty near the stairs or jumping up on things!

Trazodone

Another drug used with cats is Trazodone. Trazodone is an antidepressant that is commonly prescribed for insomnia and depression in humans. Like gabapentin, one of its side effects is drowsiness and possibly anxiety reduction.
Trazodone can be combined with gabapentin if your vet feels that gabapentin does not provide enough sedation.

Typical dose is 50 mg given by mouth 90 minutes before the stressful event. Trazodone does lower blood pressure in cats (see reference below) and may have a higher risk of serotonin syndrome if used with other anti-depressant medication such as fluoxetine (Reconcile). Trazodone is available as a tablet or can be compounded into a liquid or capsule form.

Supplements

If you feel your cat is fairly calm and you are not ready to go the drug route, a calming supplement in place of medication can help a cat relax at the vet. Supplements can help reduce a cat’s anxiety but will not induce the sedation afforded by gabapentin and trazodone.

Zylkene contains a protein derived from milk (alpha casozepine) that has been shown to induce calm behavior in cats (see reference below) It is recommended to start the supplement about 2 days prior to the vet visit. Most cats like Zylkene and will readily eat it sprinkled on their food.

L-theanine is an amino acid that occurs naturally in green tea leaves. It has been shown to keep cats and dogs relaxed (see reference below) and comes in a tasty chew tablet. Solliquin (Nutramaxx) and Anxitane (Virbac) are two veterinary-labeled supplements containing L-theanine. Start the supplement per manufacturer’s directions 2-3 days before the vet visit.

Supplements or medication can help a cat relax at the vet and complement the training you have done to reduce your cat’s anxiety at his vet visit. Your cat will be less anxious and more willing to draw on what he has learned before and to accept new experiences. Given under your veterinarian’s supervision, these drugs and supplements are safe and effective. While the supplements are palatable, gabapentin and trazodone are bitter, which some cats may find aversive. In the next post, we will see what we can do to encourage your cat to take a bitter pill.

references:

1. Fries RC, Kadotani S, Vitt JP, Schaeffer DJ. Effects of oral trazodone on echocardiographic and hemodynamic variables in healthy cats. Journal of Feline Medicine and Surgery. 2019;21(12):1080-1085. doi:10.1177/1098612X18814565

2. Makawey A, Iben C, Palme R. Cats at the Vet: The Effect of Alpha-s1 Casozepine. Animals (Basel). 2020 Nov 5;10(11):2047. doi: 10.3390/ani10112047. PMID: 33167443; PMCID: PMC7694447.

3. Dramard, V., Kern, L., Hofmans, J. et al. Effect of l-theanine tablets in reducing stress-related emotional signs in cats: an open-label field study. Ir Vet J 71, 21 (2018). https://doi.org/10.1186/s13620-018-0130-4

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A feline practitioner listens to this cat’s chest in his preferred position.

What can your cat expect at her veterinary exam? The typical exam starts at the head and works through the body to the tail. This way health vitals are systematically collected. But it is important that the feline practitioner pay attention to the individual cat. For example, if your kitty seems to have pain in her mouth, in the cat friendly exam the vet may work through the rest of the exam first, and address the possibly painful mouth last. Saving the worst for last keeps your cat from anticipating pain throughout the entire exam.

Cats prefer high-intensity interactions that don’t last long. So, your cat may be offered a break between parts of the exam. Your cat may enjoy treats, toys, or gazing out a window during these breaks.

The Cat friendly Exam

Auscultation of the chest
Here your vet “listens” to your cat’s heart and lungs, measuring a heart rate and respiration rate in addition to noting abnormal heart rhythms (eg. heart murmur) and abnormal breathing sounds (eg. congestion). The vet typically will approach the cat from the back or side and use a stethoscope.

Head and Neck examination
Parts of this exam may happen even before your cat is on the exam table. Head tilts and facial swellings can be observed from a distance while your cat is walking around the room. In the more hands-on part of this exam, your vet may use an ophthalmoscope or otoscope to check the eyes and ears. He or she will also raise your cat’s lips to get a look at her teeth and open her mouth to check the oral cavity and get a quick look under her tongue.

Abdominal Palpation
In this part of the exam, the vet massages your cat’s belly to feel her intestines, kidneys, and bladder. It is also a check for possible growths in the abdomen and thickened walls in the intestines and bladder.

Back and limb assessment
This part of the exam includes assessment of the muscles along the spine and legs. The paws will also be evaluated and the claws extended.

Under the Tail Check
A quick look under the tail for fecal debris, swelling, and discharge… completes the exam.

Reference: “2022 AAFP/ISFM Cat Friendly Veterinary Interaction Guidelines: Approach and Handling Techniques”, Rodan et al., Journal of Feline Medicine and Surgery, Volume 24, Issue 11, November 2022, Pages 1093-1132

the cat friendly exam: practice at home

Some of the handling your cat may encounter at his vet visit includes being lifted up onto an exam table, getting weighed on a scale, sitting on an exam table to have his chest auscultated, having his head and mouth examined, and having his back and legs massaged and handled.

You can practice some of the cat friendly exam handling with your cat at home. Training some basic behaviors such as “pick up“, “sit” and “target” can make this a pleasant experience for you and your cat.

First – choose an area at home where you will train
Pick a table, counter, or dresser (avoid the kitchen table or counter) where you can set up your “exam room”.
You can purchase a baby scale to weigh your cat if you want to monitor his weight or just get the bathroom scale and place it on your counter. The weight from the bathroom scale will not be accurate but your cat will have the experience of getting on a scale.

Fast Forward…
Let’s say you have trained your cat to be picked up, to sit and to target. Your practice vet visit at home may go something like this:

Give your cat the “UP” cue and gently lift him (support his front and back body) and place him on the counter. Make sure to reward him (treats, head rubs…).

Once on the counter, use your target stick or finger, to guide him to walk over to the scale and climb on it. Once he is on the scale, ask him to “Sit”. Reward him when he sits.

Next, ask him to get off the scale using the target stick or your finger and have him sit on the counter.

Approaching him from behind, rub his head and hold it gently. Work up to lifting his lip to view his upper teeth. Reward and repeat on the other side.

To evaluate his feet, massage each foot, gently extending his claws – reinforce cooperative behavior with a reward.

Give your cat the pick up cue, and gently put him back on the floor. Reward him for a job well done!

It does take some time to train your cat to be picked up, sit, and target and combine these behaviors as outlined above. And – unless your cat is used to performing away from home – he may not go through his home routine at the vet clinic, especially if he is being handled by strange people. But the handling in the cat friendly exam will be familiar due to his practice exams at home and should not trigger him to engage in protective or defensive behaviors.

Cats that are used to being handled do not get as stressed and anxious as those who are only handled occasionally. A cooperative cat needs little or no restraint and can often be examined by one person. Make sure you let your vet know which behaviors your cat is familiar with and what the cue is for each one.