Category: Cat Care

The Owner’s Role in Introducing Dogs and Cats

Posted on by felinepurrspective_u3q4o6

A cat and dog relax together

Although the expression “fight like cats and dogs” refers to people who are always arguing and fighting, cats and dogs can coexist in peace and harmony.  A slow, gradual introduction provides a foundation for positive and predictable interactions between dogs and cats.

The owner’s role in introducing dogs and cats

Slow, Gradual Introduction – Off to a Good Start

It is wise to be pro-active when introducing dogs and cats.  There are two styles of introductions (Reference 1):

Owner-led introductions

  • Owner uses strategies that prevent dogs from being aroused around the cat.
  • Strategies include distractions such as food treats and encouraging calm behavior.

Pet-led introductions

  • Owners put the pets together expecting them to “work it out”.
  • Behaviors indicative of stress in cats (aggression toward the dog, vocalization, hiding) are common.
  • Risk of injury to either pet is more likely.

How to Lead when Introducing Dogs and Cats

Introducing dogs and cats is surprisingly similar to cat-cat introductions in terms of swapping scents, no visual contact initially, and supervised visits with a barrier in between.  Experts recommend a multi-stage process rewarding both the cat and the dog for calm behavior (Reference 2):

Stage One – the New Pet Arrives

  • Set up a dog zone and a cat zone before bringing the new pet home
  • Allow the resident pet to become comfortable in his or her “zone”.
  • “New” cats do better if confined to a small space initially (see Moving with Your Cat).
  • Keep the dog and cat separate at first for a few weeks. Exchange bedding daily during that time so that each animal gets accustomed to the other’s scent.

It takes a dog about 3 weeks to destress and start settling into their new home and new routines (Reference 2).

Stage Two – Initial Visitations

  • Have two people – one to manage the cat and one to manage the dog.
  • Always use a barrier between the two pets.
  • Don’t force the cat to come to the barrier – wait until he is resting somewhere you can bring the barrier and the dog to him.
  • Consider using a free-standing accordion-style baby gate as a barrier.
  • Allow the cat to leave the area if he/she desires.
  • Have the dog on a leash.
  • Reward calm behavior by both pets with tasty treats.

Stage Three – Intermediate Visitations

  • Remove the dog’s lead and continue to use the barrier.
  • Reward the dog and the cat for calm behavior.

Stage Four – Advanced

  • Remove the barrier but keep the dog on a leash.
  • Continue to reward both the cat and the dog for calm behavior.
  • Gradually increase the duration of the face-to-face time as long as both pets are calm.
  • Be sure to supervise the dog and cat when the leash is removed.

Always make sure the cat has escape routes to safe places – these can be high cat trees, cat flaps in doors to closets or other rooms, the tops of bookcases or high closet shelves (Space Cats Vertically).

This cat can CHOOSE to go higher or to another room if he wants to avoid strange people or animals.

 

Remember that it is natural for dogs to chase cats – buried under the layers of domestication is an animal that chased down small prey to eat and survive. It is also natural that cats will run when threatened by a large predator, trying to reach a safe zone, like a tree.  In Owner-led introductions, the chase sequence is interrupted. These introductions tend to be more successful than pet-led introductions.

 

 

Rewarding calm behavior

When your dog first sees the cat, click (if using a clicker) or say “good” and see if he will take a treat. If he  is whining, barking, stiff, tense or staring at the cat, walk him away from the barrier until you reach a distance where he is relaxed and calm. Reward him with a treat when calm.

Watch your cat for signs of stress – if she is crouched and slinking away, hissing, growling, try to lure her to a place where she is more comfortable, say a high cat tree, where she can observe the newcomer from a safe place. Reward with a high value treat.

Introducing dogs and cats can take weeks to months, depending on the pets.  After your new dog or cat is settled in, you can start slow, gradual introduction. Be sure to monitor the pets’ body language and don’t hesitate to return to an earlier step if things are not going well.

 

A Useful Behavior

Dog owners will find it useful to teach their dogs to ignore food on the ground, other dogs, and small animals (such as cats). This is a useful behavior when introducing dogs and cats.

“Leave It!” is more than just having the dog ignore the food or other animal. One of the key points in this behavior is when the dog focuses his/her attention on you instead of the food or other animal. He is looking to you for guidance.

This behavior is trained in stages but usually starts as follows (Reference 3):

  • Place a treat on the floor and put your hand over it.
  • Have a higher value treat behind your back or in your pocket.
  • Your dog will most likely try to get the treat, sniffing and pawing at your hand.
  • Say “Leave It!”
  • When she stops trying, click with a clicker or say “good”.
  • Offer a higher value treat as she looks up at you.

This behavior can be generalized to include small animals, people or other dogs. In the case of introducing dogs and cats, you can use “Leave It!” to direct your dog’s attention away from the cat to yourself.

references

  1. Kinsman, R.H.; Owczarczak-Garstecka, S.C.; Casey, R.A.; Da Costa, R.E.P.; Tasker, S.; Murray, J.K. Introducing a Puppy to Existing Household Cat(s): Mixed Method Analysis. Animals 2022, 12, 2389. https://doi.org/10.3390/ani12182389
  2. Introducing Your New Dog to an Exisiting Cat. December 5, 2023. https://www.battersea.org.uk/pet-advice/dog-advice/introducing-your-new-dog-existing-cat. Viewed 4/2024
  3. Gibeault, Stephanie. “Leave It” Command: Training Your Dog to Ignore Food and Other Items.  March 14, 2024. https://www.akc.org/expert-advice/training/learning-the-leave-it-command/.  Viewed 4/2024.

Why Vaccinate Your Indoor Cat for Rabies

Posted on by felinepurrspective_u3q4o6
Rabies vaccines are typically given in the Right hind leg below the knee (in the area highlighted in green).

It is not uncommon for some cats to live completely indoors and have little contact with other animals. Do these cats really need rabies vaccines?

 why Vaccinate your indoor cat for rabies

Rabies is one of the oldest diseases known to man – there are records of cases 4,000 years ago (Reference 1). Rabies is caused by a virus; infection with rabies results in a progressive inflammation of the brain and spinal cord. It is a disease of mammals – fish, reptiles and birds do not contract rabies nor do they carry rabies. Rabies is 100% fatal once clinical symptoms appear (Reference 2).

Rabies has two clinical forms (Reference 3):

  • Furious: symptoms are hyperactivity, hallucinations, lack of coordination, fear of water and fear of fresh air. Death occurs after a few days due to cardio-respiratory arrest.
  • Paralytic: Muscles become paralyzed starting at the wound site. Coma develops and eventually death occurs.

About 20% of rabies cases in humans are the paralytic form.  Neither version of rabies is a pleasant way to die.

Rabies is estimated to cause at least 59,000 human deaths worldwide very year. In the US, only 1-3 cases are reported every year but 60,000 Americans get post-exposure treatment yearly after being bitten or scratched by a rabid animal (Reference 4).

Rabies – how is it transmitted?

Rabies is transmitted via the saliva of infected animals. Worldwide, 99% of cases result from bites of rabid dogs. (Reference 3)

In the U.S., 90% of reported cases in animals occur in wildlife, primarily raccoons, skunks, bats and foxes (Reference 4).  Most human deaths in the U.S. from rabies (70%) are due to contact with infected bats (Reference 4).

A bat bite or scratch is very small and may be overlooked. Finding a bat in the house, particularly in a bedroom where someone was sleeping, warrants catching the bat and contacting your local health department for testing (Reference 5).

Rabies is diagnosed by detecting rabies virus antigens in brain tissue using a Direct Fluorescent Antibody (DFA) test. The animal must be euthanized to carry out this test (Reference 4).

rabies – treatment

Rabies is a disease that cannot be cured but can be prevented.  After being bitten by a possibly rabid animal, a person must do the following to survive (Reference 4):

  1. wash the wound with soap and water
  2. receive a post-exposure rabies vaccine
  3. infiltrate the wound with rabies immunoglobulin or monoclonal antibodies if deemed necessary

why Vaccinate your indoor cat for rabies

In the U.S., most states or local health departments require that dogs and cats be vaccinated for rabies. The vaccine must be given by a licensed veterinarian.  This ensures that the vaccine has been stored and administered properly and will be effective in the event your cat is bitten by a rabid animal. If the vaccine is not given by a veterinarian, the cat or dog is considered unvaccinated. 

Dogs, cats and ferrets that are bitten by a potentially rabid animal and have never been vaccinated must be euthanized.  Unlike humans, there is no post-exposure rabies vaccine for these animals (Reference 2). Vaccinated animals that have had exposure to rabies are re-vaccinated immediately and quarantined for at least 45 days.

If your cat bites someone, the physician treating the bite must notify the health Department. You must confine your cat for 10 days.  If she is ill or becomes ill during the 10 day period, a veterinarian must evaluate her for rabies (Reference 2).  This is another reason to vaccinate your indoor cat for rabies – proof of vaccination can forestall the health department from recommending euthanasia or  quarantining your cat at a veterinary facility.

Vaccinate Your Indoor Cat for Rabies – Vaccines

There are two types of rabies vaccines recommended for cats in U.S. (Reference 6):

Inactivated:

  • pathogen is unable to replicate in the host
  • contains adjuvants and other proteins to promote immune response
  • vaccines containing adjuvants cause more inflammation than vaccines without adjuvants

Recombinant:

  • manipulation of the DNA of the pathogen reduces its virulence
  • recombinant vaccines for cats in North America incorporate the pathogen DNA into the canarypox genome
  • do not contain adjuvants

Kittens are typically vaccinated with their first rabies injection at 12-16 weeks of age. The next rabies vaccine is usually given at the 1 year anniversary of the initial vaccine; thereafter the owner has the option of annually vaccinating the cat or giving a vaccine approved  for 3 years if this vaccine is accepted by local laws/regulations.

Side Effects of  Vaccines

In a 2005 study (Reference 6), only 0.52% of cats had a reaction within 30 days of having a vaccine. These mild reactions included sleepiness, reduced appetite, mild fever or tenderness at the injection site.

More severe reactions are rare but can include vomiting, diarrhea, or facial swelling. Often these reactions can be mitigated by giving an antihistamine or steroid prior to vaccination (Reference 6).

Feline Injection Site Sarcomas (FISS) (Reference 6)

  • malignant (cancerous) tumors recognized in the 1990’s
  • these rapidly growing tumors occurred at the site where the vaccine was injected. 
  • FISS is estimated to occur in 1-4 cats per every 10,000 cats vaccinated
  • Injections of vaccines and long-acting drugs have been associated with FISS

Rabies vaccines are typically given in the right hind leg below the knee.  If an injection site tumor develops, the amputation of the leg offers a life-saving cure for the cat. 

why vaccinate your indoor cat for rabies?

Even if your cat is 100% indoors, there is always a risk she may escape outdoors and encounter a rabid bat or raccoon. Alternatively, rabid bats and raccoons have been know to enter houses.  Your cat may bite someone. If you decided not to vaccinate your indoor cat for rabies, you may be looking at euthanasia or an expensive quarantine at a veterinary facility.

If your cat is vaccinated, it protects not only her but you and your family, too.  There is no cure for rabies, only prevention.

Rabies vaccines are safe for most cats. Your veterinarian is your best resource – discuss your cat’s vaccination needs and health history with him or her.

references 

  1. Koury R, Warrington SJ. Rabies. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448076
  2. Animal and Rabies. Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP). January 26, 2022.https://www.cdc.gov/rabies/animals/index.html Viewed 4/24
  3. Jordan, J. Rabies. World Health Organization. https://www.who.int/health-topics/rabies#tab=tab_1  Viewed 4/24.
  4. Rabies in the U.S. Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP). April 6, 2020. https://www.cdc.gov/rabies/location/usa/index.html Viewed 4/24.
  5. Avoid Risk of Rabies from bats. Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP). https://www.cdc.gov/rabies/location/usa/index.html March 9, 2022. Viewed 4/24
  6. Stone AE, Brummet GO, Carozza EM, Kass PH, Petersen EP, Sykes J, Westman ME. 2020 AAHA/AAFP Feline Vaccination Guidelines. J Feline Med Surg. 2020 Sep;22(9):813-830. doi: 10.1177/1098612X20941784. PMID: 32845224.

 

 

 

 

 

Moving with your cat

Posted on by felinepurrspective_u3q4o6

“Moving with Your Cat” was originally published 9-26-21. This newer version has been updated and contains additional information.

Moving to a new home is stressful even when everything goes right! Imagine how confusing moving is to our cats – the boxes are fun when empty but soon they fill up with things and your cat can no longer jump in.

 

From the Feline Purrspective…

The bed you used to siesta on gets bagged up and taken away by strange humans. Your world seems to be coming to an end. Will you have enough to eat? Will you be safe from predators? Where can you hide?

Cats are territorial animals. An outdoor cat’s home range is the maximum area he roams and hunts in. Within the home range is a smaller area that the cat will actively defend – his territory. Inside this defended area is a smaller area called the “core territory”, where the cat can rest, has shelter, and feels safe from predators and other cats. Moving with your cat removes him from his core territory – the house or apartment he lives in.

How can we communicate safety and security to our cats when we move? Somehow, we cat owners have to provide what our cats need even though we are no longer “at home”.Needs of Domestic cats

What our cats need:

  1. Resources : food, water, litter box, shelter
  2. Safe access to resources
  3. Belonging: territory
  4. Human interaction: predictable
  5. Playtime: predatory behavior

Moving with Your Cat

Getting ready

  1. Resources: Stock up on your cat’s preferred litter and food – if you are traveling by air, perhaps you can ship some of this to your new address.
  2. Safe access to resources: Create a “safe place” for your cat. When moving with your cat, this will most likely be her carrier.  Make sure your cat is comfortable in her “home away from home”.  In the weeks leading up to the move, leave it out for her to explore and nap in. Consider feeding her meals in it.
  3. Set up a “mobile” territory: A lot of cat communication is by smell. Cats have some of the best noses -with 30 genetic variants of the V1R receptor protein in their vomeronasal organs, they are able to discriminate between a wide variety of smells (Reference 1). So, avoid laundering cat blankets or quilts that your cat sleeps on – the familiar scent of home can help reassure your cat of his territory when he is on the move.
  4. Predictable, positive human interaction: Try to maintain daily feeding and grooming routines as you travel.
  5. Predatory play: Don’t forget play time – try to set some time aside to play with your cat when traveling.

Other things to consider when moving with your cat:

  • Is your cat microchipped in case he escapes?
  • Consider a calming supplement such as Zylkene, Calming Care. It is best if you start these several weeks before moving.
  • Have copies of your cat’s medical records. Locate a cat-friendly practice in the new neighborhood.
  • Do you need a health certificate for travel?
  • Consider getting your cat accustomed to wearing a harness and leash. Even if not fully leashed trained, a harnessed cat can be more easily handled in an airport or at a rest stop if you have to change out soiled pads in the carrier.
  • Consider asking your vet for calming medication for travel.
  • Multi-cat homes: Identify the social groups in your home before moving.  This can help you when introducing your cats to their new territory.

 

moving day

Although some cats travel well together, it is usually a good idea to have separate carriers for each cat in case some random event frightens one of the cats, resulting in a cat fight.

You may want to keep your cat(s) in their own room with their carriers while furniture, etc is being moved – you don’t want them to escape!

Arriving at your new home…

  • Establish a “safe place” for each cat or social group: Choose a room with a door you can close, that does not have places where your cat can hide (under the bed, behind a bookcase) and you can’t get him. Use one of your smaller moving boxes as a hiding space – put a comfy bed or blanket in this box. 
  • The “safe” room should contain all your cat’s essential resources – food, litter box, water, scratching post.
  • Use pheromone diffusers in the “safe place”. You may also want to have them throughout the new house or apartment.
  • A gradual introduction to the new house is best for most cats. Pay attention to your cat’s body language – if she seems scared or frightened, allow her to stay in the “safe room”. Once she seems curious about the world outside her safe place, allow her to explore the rest of the house – you may want to accompany her (a harness/leash can be handy) on her first forays into the new space.
  • Maintain feeding and play/grooming routines as best as you can.

In a multi-cat homes, you may want to use a protocol similar to introducing cats. Assess how the different social groups are adjusting before allowing free access to everything. A move can disrupt the social order, giving a dominant cat an opportunity to pick on a more timid cat.

Moving with your cat is an adventure…

When your cat arrives at his or her new home, he/she must establish a “new” territory.  We can facilitate this process by:

  • ensuring that your cat has familiar items with her – the food and litter she is accustomed to, beds/blankets that have her scent on them, and a carrier she is comfortable in 
  • allowing him to establish a new “core” territory first in a “safe” room
  • allowing her to choose when she is ready to leave her “safe” place to explore the rest of the house.

Moving is stressful for us and for our cats.  Make sure to monitor your cat(s) for sickness behaviors. Reduced appetite, vomiting, or diarrhea can be signs of stress-related issues. Consult a veterinarian if these problems don’t resolve in a day or two or if your cat does not eat for more than 24-48 hours.

references

  1. Kristyn R. Vitale Shreve, Monique A.R. Udell, Stress, security, and scent: The influence of chemical signals on the social lives of domestic cats and implications for applied settings, Applied Animal Behaviour Science, Volume 187, 2017, pp. 69-76, ISSN 0168-1591, https://doi.org/10.1016/j.applanim.2016.11.011

 

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Managing the Painful Cat: Recognizing pain and Giving Care

Posted on by felinepurrspective_u3q4o6

Pain is a response to injury and illness.  It motivates an animal to protect the wounded part of the body or  to slow down to allow the immune system to work.  But at a certain point, pain may not be functional – for example, if an animal is too painful to eat. Managing the painful cat must reduce pain without inducing dysphoria – a state of unease and dissatisfaction (Meriam-Webster).

Cats are not only predators, they are also prey for larger carnivores like coyotes. A predator will target a weak or injured prey animal so it is important that prey animals hide their pain, so they don’t become some else’s snack. How do we recognize pain in a cat? How do we manage the painful cat?

Managing the Painful Cat

Managing the painful cat requires that:

  1. We recognize the pain and its severity.
  2. The veterinary team formulates a treatment plan, which includes pain medications and supportive treatments.
  3. The cat owner implements the plan, monitoring the cat’s pain and response to treatment.

Pain can divided into “acute” pain and “chronic” pain.

Acute pain (Reference 1):

  • rapid onset
  • short duration (3 months or less)

“Chronic” pain (Reference 1)

  • occurs along with a chronic health condition
  • longer duration

We will focus on “acute” pain in this article.

Some causes of “acute” pain are:

  • surgeries: spay, neuter, dental extractions
  • illness such as pancreatitis, infections
  • bite wounds from a cat fight

How do you know if your cat is in pain?

Changes in behavior, posture, and temperament may be indicators of pain or illness. Some examples are:

Changes in behavior

  • decreased appetite
  • decreased grooming
  • urinating or defecating outside the litter box
  • sleeping in unusual places

Changes in posture

  • hunched or crouching
  • changes in gait: walking stiffly, limping

Changes in Temperament

  • a typically friendly cat does not greet you and hides under the bed
  • the cat is aggressive toward people or other animals

If you notice such changes, a visit to your vet is in order. Your vet may prescribe therapeutic and pain medication, suggest environmental changes and other supporting therapies such as warm or cold compresses. During the treatment and recovery period, it is important to monitor your cat and note her response to therapy:

  • behavioral changes: is there improvement
  • pain assessment

 

The Feline Grimace Scale (FGS) provides cat owners with a way of assessing acute pain. The FGS focuses on 5 features of the cat’s face: position of the ears, shape of the eyes, shape of the muzzle, attitude of the whiskers, and position of the head. The user assigns each feature a score of 0 (no pain), 1 (moderate pain), or 2 (obvious pain) for a maximum of 10 points. A score of 4 indicates that the cat is painful. To use the FGS, see https://www.felinegrimacescale.com/

Effective pain management enhances healing and will help the cat return to its daily activities faster. Be sure to give medication as directed by your veterinarian. If you have difficulties administering medication or following other instructions, contact the vet clinic immediately for alternative ways of giving medication or other methods of providing supporting therapy.  If you feel your cat is in pain in spite of the prescribed treatments, contact your veterinary team – perhaps another medication or therapy will be more effective.

“ It is reasonable to assume that anything that would cause us pain, will also cause pain in cats
and be just as distressing for them” (Reference 2)

Managing the painful cat not only involves giving prescribed medication and treatments in a timely way, it also includes keeping the patient physically comfortable.  Environmental modifications can help the painful cat return to the comfort of his daily routine.

Environmental Modifications to Help the Painful Cat Recover (Reference 2)

  • Restrict outdoor access and activity as directed by your vet
  • Provide options for quiet rest, ensuring the bed is in easy reach
  • Essential resources – food, water, litter box and bed –  must be close by. The recovering cat may not want to move very far.
  • Encourage your cat to eat by offering palatable foods and warming them when appropriate, per your veterinarian’s instructions.
  • Keep other pets and children away if they are likely to disturb the cat or, for example, disturb a bandage.

managing the painful cat: A Case History

In the autumn of 2021, I was taking my cat Gus on short hikes on a nearby mountain trail. One hike, he startled, I lost hold of the leash and he disappeared up the trail. After 2 hours of walking up and down the trail, calling for him, he appeared, without harness and leash, moving stiffly. I carefully put him in his backpack and took him to the vet clinic for an exam and x-rays.

The exam indicated that he had a lot of inflammation in his lumbar spine and was reactive to palpation of that area. X-rays did not show any injury to his skeleton.

We tried NSAID therapy, oral opioids and gabapentin, but there was little improvement in 3 days. Gus was so painful that he would growl when changing positions.

The next visit was to the neurologist in Denver for an MRI which showed inflammation but no obvious nerve damage. We added a steroid to his therapy; I also gave him twice daily red light therapy.  Gus began to improve and recovered fully after 6 weeks.

environmental modifications

  • Gus was set up in the master bath with the doors closed to keep other cats from entering
  • A litter box with a low entrance was provided
  • A bed made of blankets was placed on the floor
  • A bowl of water was next to the bed

giving medications

  • A decreased appetite precluded Gus voluntarily taking a pain medication in a treat
  • Medication was administered using a squeeze up treat (see “How to Give Your Cat a Bitter Pill“)

the efficacy of pain medication and an environment conducive to healing

 

Although the “tincture of time” was an important factor in Gus’s recovery, alleviating pain and discomfort accelerated healing.  The addition of prednisolone (a steroid) to the therapy helped reduce swelling in Gus’s spine – he began to move about more easily the day following his first prednisolone dose. The steroid also stimulated his appetite and having a bed on the floor with easily accessed litter box nearby encouraged elimination.

In the weeks that followed the hiking accident, Gus gained mobility although steps to access high places were still needed.  At first, Gus was not able to hold his tail up but he recovered fully in the weeks that followed.

Managing the painful cat requires recognition of pain and a treatment plan from the veterinarian.  After that point, the cat’s care is in the hands of his owner who must  monitor him for pain, ensure that he eats and eliminates, and provide him with an environment conducive to healing.

 

references

  1. Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S. 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. Journal of Feline Medicine and Surgery. 2022;24(1):4-30. doi:10.1177/1098612X211066268
  2. Recognising and Managing Acute Pain in Cats:Information for Owners/Caregivers.  https://icatcare.org/app/uploads/2022/02/Cat-Carer-Guide_Acute-pain.pdf  viewed 3/2024

 

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The Final Goodbye – When to Put Your Cat to Sleep

Posted on by felinepurrspective_u3q4o6
Marley 2/2006- 2/24/2024

 

Saying the final good bye to your cat is never easy. Medical care for cats has progressed by leaps and bounds in the past few decades and it is not uncommon for cats to live to be 19 or 20 years old. As age takes its toll and the older cat’s mind and body declines, many cat owners hope that their old friend will slip away in her sleep. Unfortunately, this does not happen often and we need to decide if it is time for euthanasia.

The word “euthanasia” comes from the Greek: “eu” or well, and thanatos, “death”, i.e. – the good death. A “good death” is the last gift we can give our cats.

The decision to put your cat to sleep is not made lightly.

  • The cost of medical care may be out of your reach financially and you elect euthanasia rather than have your cat suffer untreated.
  • You may have done all the medical treatments possible and your cat is just not responding.  You must say goodbye.

But, what about the cat that clings to survival but is dwindling, still eating but not thriving? When do you say goodbye?

when to say goodbye and put your cat to sleep

In the case of the cat with the “dwindles”, it helps to make a list of what your cat does during her day. Keep an eye on these behaviors and watch for signs of apathy or disinterest.

It can be helpful to keep a calendar of your cat’s daily behavior or events (such as illness or playfulness). Each day can be evaluated as “good”, “bad” or “average”. When the “bad” days outnumber the “good” ones, it may be time to put your cat to sleep. Your veterinarian can help you with assessing your cat’s quality of life.

Last week I said goodbye to Marley, one of “The Feline Purrspective” team.  Marley was a gentle, extremely sociable cat who enjoyed head rubs and treats. He was friendly with people and fairly tolerant of other cats. His health was generally good until he was about 16 years old.  He will be sorely missed.

Marley’s timeline is summarized in the table below. I have highlighted the concerns that contributed to the decision to euthanize.

AGE TIMELINE OF LIFE EVENTS
3-14 years
  • I adopt Marley from the veterinary technician school I attended.
  • Marley is introduced to my 3 cats and becomes part of my household.
  • He learns to go on morning walks and participate in the evening treat and playtime.
  • He becomes quite adept at food puzzles.
  • His health is good although he does seem to lose teeth at his annual dental cleanings.
14-16 years
  • Marley has two instances of malignant tumors on the bottom side of his tongue, which were successfully removed.
  • His health and demeanor remain good overall: he still goes on daily walks and participates in evening treat and play time.
16-17 years
  • Marley’s vision and hearing begin to deteriorate.
  • He starts to show signs of Cognitive Dysfunction Syndrome (CDS) and starts a Sam-E supplement.
  • He stops going outside with the other cats on walks.
  • He is still chasing treats at night but does not play with toys.
17-18 years
  • September, 2023: a firm, fibrous mass is found in front of Marley’s left ear.
  • I decline surgery due to Marley’s progressing CDS.
  • Marley is becoming less active and seems fearful of the other cats at times. He still comes for treats most nights.
18+ years
  • Marley turns 18 years in early February 2024
  • The tumor on his head has increased in size and his left eye is starting to close and squint.
  • He spends most of his time in a heated basket, leaving only to use the litter box or to eat.
  • He is no longer grooming himself and has stopped coming for treats at night.

Looking at the highlighted sections in the table above, you can see that going for walks outdoors and the evening treat/play time were key activities in Marley’s daily life.  By the time he is 16-17 years old, he has stopped taking the daily walk but still participates in the nightly treat time. In the next year, he stops this activity.

These behaviors defined who Marley was and were indicators of his will to live.  In the final months of his life, he lost this will to live.  It was time to say goodbye.

the final goodbye

On February 24, 2024, I said a final goodbye to Marley. I gave him some gabapentin before taking him to the clinic for euthanasia. He passed quickly and peacefully in his basket – he was gone before finishing his favorite treat and before all the euthanasia solution was injected.

The decision to euthanize Marley was based not only on the progression of his medical condition, but also on the changes in his behavior. I feel he was not in pain but his life was no longer worth living. From a friendly, outgoing cat, he had become a reclusive, confused creature, going through the motions of surviving. I don’t feel that his last years were mismanaged but I do feel it may have been kinder to let him go a few months earlier.

I have shared my experience in the hopes that it can help other cat owners who are wrestling with this very difficult question: when to put your cat to sleep.  I found it helpful to pay attention to Marley’s daily activities, and note how often he participated in them and when he just stopped doing them. Tracking these key behaviors can give you, the cat owner, an idea of your cat’s mental state: is he is still engaged in life or just going through the motions? If he is just going through the motions, is it time to say goodbye?

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Strategies for Managing Hairballs in Cats

Posted on by felinepurrspective_u3q4o6
Canned food spread on a textured silicone mat can give your cat the enjoyment of licking without ingesting fur.

As you are en route to the bathroom during the night, your foot contacts something tubular and mushy – another hairball! I have lived with over a dozen cats – some I have shaved to reduce the hairball menace; others I have dutifully given the hairball gels, which promise to lubricate the cat’s GI (gastrointestinal) tract to help the hairball pass. But, are hairballs normal, part of something you have to put up with when owning a cat?

Hairballs are rare to non-existent in feral cats and zoo cats. Why do our domestic cats get hairballs? Hair that is ingested during normal grooming activities passes out the intestines in the stool. On average, a short‐haired cat loses about 28 g of hair per kg of body weight each year. Two‐thirds of this hair consumed while grooming is found in the stool (Reference 1). The more the cat grooms herself, the more hair she consumes. Couple this with slower gastric emptying, hair can accumulate in the stomach, forming a hairball.  Here are the “why’s” and “how’s” of managing hairballs in cats.

managing hairballs in cats

If a hairball becomes too large to pass through the GI tract, the cat usually expels the hairball by vomiting. However, if vomiting is not successful, we risk (Reference 2)

  • intestinal obstruction
  • obstruction of the esophagus
  • hair lodging in the nasopharynx (top part of the throat throat just behind the nose) causing sneezing, retching, and nasal discharge

How Common Are Hairballs in Cats? (Reference 2)

  • 73% of cats have never had a hairball
  • 17% cats bring up a hairball once a year
  • 10% bring up two or more hairballs in a year
  • Long-haired cats are twice as likely to vomit hairballs than short-haired cats

When Do We See (or Step on) Hairballs?

  • Flea infestations can lead to increased grooming
  • GI motility is decreased due to food intolerance or gastrointestinal disease
  • The cat is “over-grooming” due to anxiety

What to Do About Hairballs

Chronic gastrointestinal disease, pain, and/or stress can change how fast hair and food move through the GI tract. Your first stop should be your veterinarian’s office. Appropriate management of GI disease can significantly reduce hairball vomiting (Reference 2). Your vet will consider dietary therapy and run diagnostics to detect GI disease.

Diet and Hairballs

Diet may be helpful in managing hairballs in cats. Studies have found that diets containing moderate levels of fiber (11-15% total dietary fiber) can minimize hairball formation, particularly in long-haired cats. Fiber aids in increasing the amount of hair passed out in the stool (Reference 1).

Hairball diets also have larger sized kibbles. Radiographic studies have linked larger kibbles with hairballs exiting the stomach and passing out in the feces (References 1, 2).

Consider feeding more canned food.  Canned food passes through the GI tract more quickly (about 4 hours) compared to dry kibble (14-16 hours) (Reference 2).

The following strategies may help reduce the amount of hair ingested and promote GI motility (Reference 2).

  • daily grooming to reduce loose hair
  • shaving long-haired cats
  • monthly flea prevention
  • increase gastric emptying by feeding frequent small meals rather than large meals
  • use petroleum-based laxatives to lubricate the intestinal tract easing the passage of hairballs
  • prokinetic drugs (metoclopramide, cisapride, ranitidine) promote GI motility

hairballs in cats: environmental modification

The GI tract is very responsive to psychological stress.  Stress, chronic GI disease, and pain are factors that can affect how fast ingesta are processed by the GI system (Reference 3).

Domestic cats spend 25-30% of their waking hours grooming; those kept solely indoors may spend even more time at this task. Grooming may increase when the cat is stressed or bored.

Enironmental modification gives us a way to reallocate the cat’s time budget – giving him/her other activities to do, in addition to grooming. It also helps us reduce the stress perceived by the cat. In addition to providing the requirements for a healthy feline environment, the following strategies can affect the feline time budget.

  • feeding frequent small meals (may also help with gastric emptying)
  • incorporating species specific behaviors in feeding strategies (Why Meal Feed Your Cat)
  • providing outdoor access in an enclosure or on a harness and leash
  • regular interactive play time
  • establish a routine; allow the cat control over his environment by knowing what will happen and when

Grooming is a self-soothing behavior. The use of lick mats (textured silicone mats that you spread food on) can take advantage of the satisfaction cats find in licking without hair ingestion.

Although hairballs may seem to be a nuisance behavior, frequent vomiting of hair balls is NOT normal and can be an indicator of underlying GI disease or stress. A visit to your vet can diagnose medical problems; implementing environmental modification can reduce stress that affects how much cats groom and how fast hair moves through the GI tract.

references

  1. Weber M, Sams L, Feugier A, Michel S, Biourge V. Influence of the dietary fibre levels on faecal hair excretion after 14 days in short and long-haired domestic cats. Vet Med Sci. 2015 Jul 7;1(1):30-37. doi: 10.1002/vms3.6. PMID: 29067172; PMCID: PMC5645811.
  2. Cannon M. Hairballs in cats: a normal nuisance or a sign that something is wrong? J Feline Med Surg. 2013 Jan;15(1):21-9. doi: 10.1177/1098612X12470342. PMID: 23254238.
  3. Rudinsky, Adam https://www.youtube.com/live/CkZsUYhswGk?si=dauNUIjuEBGtSvIx October 4, 2022: YouTube Live: Chronic Vomiting Cats: What Can We Do? Viewed 1-17-24

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Treating Pandora Syndrome in Cats: the Environment

Posted on by felinepurrspective_u3q4o6
An elevated perch allows this cat a good vantage point to survey her surroundings for other cats and people.

Pandora Syndrome refers to cats suffering from multiple medical ailments that do not resolve with appropriate medical treatment. Instead, the symptoms are chronic, waxing and waning in response to environmental stressors. These cats also share a history of traumatic experiences and exhibit an abnormal stress response, partly due to epigenetic changes resulting from the stressful events in their lives (Reference 1).

Pandora syndrome is an “anxiopathy” – a condition resulting from chronic activation of the central stress response system (Reference 1).

Treating Pandora syndrome in cats: the environment

Careful modification of the Pandora cat’s environment (in additional to medical therapies) can reduce the severity and frequency of the cat’s symptoms (Reference 1). One of the first studies to demonstrate the efficacy of MEMO (Multimodal Environmental Modification) studied the response of 46 cats with Lower Urinary Tract Symptoms (LUTS) to MEMO. Cat owners were asked to reduce environmental and social stressors using the following suggestions (Reference 2):

  • avoid punishing the cat
  • change to canned food
  • change to unscented, clumping litter
  • improve litter box management
  • provide climbing structures, viewing and resting perches
  • provide audio/visual stimulation when the owner was gone
  • increase interaction with the cat
  • identify and resolve conflict in multi-cat homes

The most commonly followed MEMO suggestions were:

  • increasing the amount of time interacting with the cat
  • changing to a canned diet
  • adding another litter box

During the 10 months of follow-up, no signs of LUTS were observed in 70-75% of the cats. Owners also reported reduction in fearfulness, nervousness, respiratory signs, aggressiveness, and lower intestinal tract signs (Reference 2).

Treating Pandora Syndrome in cats: MEMO

Environmental modification for the Pandora cat needs to:

  1. increase the security of the environment
  2. allow the cat to feel in control of his environment

Treating Pandora syndrome in cats: choosing the memo that suits the cat

The basic blueprint for cats’ environmental needs can be  found at https://catfriendly.com/cat-friendly-homes/what-your-cat-needs-to-feel-secure/.  Treating Pandora syndrome in cats will be most successful when MEMO is tailored to the individual cat.  Here is some additional information to consider once the basic environmental needs are satisfied.

The Fearful, Nervous Cat that Prefers to Stay Alone

For these cats, MEMO will focus on providing safe places and positive, predictable interactions with humans.

  • make plenty of hiding places available – these can be the top shelves of closets or boxes in the bottom of closets
  • increase the number of “vantage points” through the use of shelves, perches and cat trees (Reference 3)
  • increase the security of the floor space: minimize wide open spaces by positioning furniture to create places where cats can rest and hide (Reference 3)
  • use baby gates to limit the access of potential stressors such as dogs or small children to the cat’s area (Reference 3)
  • allow the cat to choose to interact with humans (https://www.felinepurrspective.com/touch-not-the-cat-interacting-with-cats/)

Treating Pandora Syndrome in Cats in the Multi-cat home

In a multi-cat house, Pandora cats may show aggression or become ill when threatened. Successful MEMO requires identifying the social groups of cats in the house and ensuring that plenty of resources are spread throughout the house. Be prepared to intercept aggression when necessary (https://www.felinepurrspective.com/managing-aggression-in-the-multi-cat-home/) – keep the peace!

Separation Anxiety

Some Pandora cats were orphans or abandoned. These cats may exhibit some separation anxiety due to a strong attachment to the owner. For example, some of these cats follow the owners around like a dog (Reference 1). MEMO can be adapted for these cats.

  1. Encourage Kitty to spend “alone time” in an enriched room or space (don’t force – maybe coax her into the room with some treats). Enrichment can be elevated perches near windows, a play tunnel with toys in it, food puzzles with snacks. Cats have a great sense of hearing and many like music – choose music designed for cats when you are not there.
  2. Establish a routine – help your cat to have control of his environment by knowing what is going happen and when it will happen (https://www.felinepurrspective.com/routines-help-cats-reduce-stress-and-anxiety/).

Many cats cope with environments that are not optimal. However, Pandora cats have suffered traumatic events in their lives resulting in epigenetic changes. These cats exhibit an abnormal response to environmental stress. Consequently, they do not cope as well as other cats with changes in their environment and develop chronic illnesses. MEMO allows these cats to feel safer and more in control of their environments, reducing their stress, and, in turn, reducing the frequency and severity of their symptoms.

references

  1. C.A. Buffington DVM, PhD, DACVN.  Pandora Syndrome in Cats: Diagnosis and Treatment; Today’s Veterinary Practice. August 10, 2018, Issue: September/October 2018. viewed on 1/06/24 https://todaysveterinarypractice.com/urology-renal-medicine/pandora-syndrome-in-cats/
  2. Buffington CAT, Westropp JL, Chew DJ, Bolus RR. Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis. Journal of Feline Medicine and Surgery. 2006;8(4):261-268. doi:10.1016/j.jfms.2006.02.002
  3. Ellis SL. Environmental Enrichment: Practical Strategies for Improving Feline Welfare. Journal of Feline Medicine and Surgery. 2009;11(11):901-912. doi:10.1016/j.jfms.2009.09.011

 

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Diagnosing Pandora Syndrome in Cats

Posted on by felinepurrspective_u3q4o6
Some of the Signs that May Indicate Pandora Syndrome

The term “Pandora syndrome” was coined by Tony Buffington of Ohio State University to describe cats with chronic clinical symptoms suffering from health issues involving multiple organ systems. Buffington initially studied a group of 200 cats that had “incurable” urinary tract symptoms (bloody urine, difficulty urinating, urinating outside the box, and urinating small amounts). These cats had other health issues in addition to the urinary tract disease.  Curiously enough, the cats’ symptoms resolved after living in an enriched environment (Reference 1).

Early studies linked the urinary symptoms to diets containing too much magnesium, causing formation of urinary stones. However, dietary changes did not resolve the cats’ urinary issues and they continued to suffer from bloody urine, difficulty urinating, urinating outside the box, and urinating small amounts, frequently in the absence of stones (Reference 1).

diagnosing Pandora Syndrome in cats

What “Pandora Cats” have in common (Reference 2):

  • history of traumatic experiences such as abandonment, orphaning, infection
  • having more than one disease at once
  • clinical symptoms that wax and wane in response to changes in the environment

More About Pandora syndrome in cats

Genetic makeup and traumatic events are thought to contribute to Pandora syndrome in cats. Our genomes (cats and humans) contains the DNA that makes us unique. DNA is made up of 4 building blocks that can be assembled in different orders. The sequence of the DNA building blocks in a gene provides the code for a particular trait such as eye or hair color (Reference 3).

However, there is more to growth and development than just genes that code for a particular trait. The science of epigenetics studies modifications to our DNA that don’t change the order of the DNA building blocks. The epigenome refers to chemical compounds that are attached to your DNA. Exposure to pollutants, what you eat, and stress are some things that can result in certain molecules attaching to your DNA and turning particular genes on or off. This is why genetically identical twins may have different skills, health, or behavior (Reference 3).

The epigenome is reset when the genome is passed on from parents to their offspring at conception. Maternal stress during pregnancy, traumatic events such as abandonment, orphaning, and infection can subsequently affect the epigenome. While many cats recover from these things, others may develop chronic illnesses or behavioral abnormalities (Reference 2).

Pandora cats are inherently “sensitive” cats who have difficulty coping with challenges presented by their environment.  They have a heightened stress response that increases the likelihood of them becoming ill.

Why the name “Pandora” syndrome?
Pandora is a figure from Greek mythology. She was a human woman made by the gods from clay.  She was endowed with many attributes, such as beauty, charm, cleverness, and curiosity. Before sending her to earth, the gods gave her a box, that she was told NEVER to open. Pandora’s curiosity got the best of her one day and she opened the box, releasing evils to plague mankind – disease, violence, greed, old age, death… However, all was not lost. Hope was also in the box to help people survive and cope with the evils in the world.

Like Pandora’s box, “Pandora cats” have multiple problems (“evils”).

diagnosing pandora syndrome in cats

A diagnosis of Pandora Syndrome is a diagnosis of exclusion – the symptoms may respond to medical therapies but then recur. Diagnostic procedures do not reveal a root cause. Diagnosis requires an extensive review of the cat’s life history, medical history and home environment. Some sample questions are below. (A more complete history form can be found in the supplementary materials of Reference 2).

Life History

  • where did the cat come from? from a shelter? was he/she a stray? an orphan?
  • are other cats/pets in the house?
  • how many people in the house?
  • indoor only? outdoor access?
  • is your cat fearful? friendly?

Medical History

  • vomiting? diarrhea? coughing? sneezing?
  • using litter box?
  • history of medical problems- e.g. allergies, heart problems?

Environmental Resources

  • safe and secure resting places?
  • multiple, separated litter boxes, feeding stations, water bowls?
  • can the cat interact with people and other pets on his/her own terms?

treating pandora syndrome in cats

Pandora syndrome is treated with medical therapies and MEMO (multimodal environmental modification).   MEMO aims to reduce the cat’s perception of threat and increase his/her perception of control of his/her environment. There is no cure for Pandora syndrome but medical therapies and MEMO can reduce the cat’s clinical signs and increase the time between episodes of symptoms (Reference 1).

The goal of MEMO is to create an OPTIMAL environment for the individual cat.  This will be the subject of the next post.

references

  1. C.A. Buffington DVM, PhD, DACVN.  Pandora Syndrome in Cats: Diagnosis and Treatment; Today’s Veterinary Practice. August 10, 2018, Issue: September/October 2018. viewed on 1/06/24 https://todaysveterinarypractice.com/urology-renal-medicine/pandora-syndrome-in-cats/
  2. Tony Buffington CA, Westropp JL, Chew DJ. From FUS to Pandora syndrome: Where are we, how did we get here, and where to now? Journal of Feline Medicine and Surgery. 2014;16(5):385-394. doi:10.1177/1098612X14530212
  3. National Human Genome Research Institute; Epigenomics fact sheet 8/16/20. Viewed on 1/6/24. https://www.genome.gov/about-genomics/fact-sheets/Epigenomics-Fact-Sheet.

 

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Managing the Diabetic Cat – Home Monitoring and Emergencies

Posted on by felinepurrspective_u3q4o6
A diabetic cat sports a fabric collar over her glucose sensor.

Managing the diabetic cat

Managing the diabetic cat is a balancing act.  The goal is to reduce the clinical signs of diabetes while avoiding complications like low blood sugar.

How do you know if the therapy your veterinarian has chosen for your cat is working?  Monitoring the clinical signs of diabetes is a start. (Reference 1).  Pay attention to:

  • Your cat’s attitude and activity level
  • daily thirst and urination
  • daily food intake
  • weekly weight and body condition score

 Your veterinarian will want to monitor your cat’s blood and urine regularly but these are “snapshots” (values at a particular time on a particular day). What is happening during a diabetic cat’s day?

monitoring Insulin-based therapies

Insulin-based diabetic therapies focus on the level of glucose in the blood.

  • Blood sugar is highest before giving one of the twice daily injections of insulin.
  • After giving insulin, the cells start to take up glucose and the level of glucose in the blood starts to drop
  • Blood sugar levels out somewhere between the morning and evening doses and starts to increase as insulin wears off
  • The lowest point in the plot is called the “nadir”; the high points in the morning and evening are called “peaks”

If you sample your diabetic cat’s blood every few hours and plot the blood glucose values on a graph, you will get a picture of how the insulin is working.

 

 

The Home Glucose Curve

Because cats are prone to stress hyperglycemia, it is best to measure these curves at home. This can be done using (1) a handheld meter and sampling every few hours or (2) a Continuous Glucose Monitoring system, consisting of an electronic sensor applied to the cat and a device to read the output of the sensor.

Blood Glucose Meter

These are like the meters used by human diabetics. Instead of pricking a fingertip, it is typical to prick the area around the vein that runs along the outside of the ear. The strip in the glucose meter soaks up the blood like a sponge and a current is generated. The strength of the signal is proportional to the blood sugar.

Continuous Glucose Monitoring System

A Freestyle sensor on the back of a cat’s neck

The Freestyle Libre is a continuous glucose monitoring system developed for humans that can be used with cats. The electronic sensor is the size of two stacked US quarters; the sensor can be scanned with a smartphone or dedicated reader device. The sensor samples every minute and stores data for 8 hours before starting to overwrite it.  It is important to scan the sensor at least every 8 hours.

Sensor life can range from a few days to 2 weeks. The sensor can be placed on the back of the neck, behind the shoulder, or on the flank. A 2″ x 2″ area is clipped and cleaned for sensor application.

A plot of the average of glucose reading recorded during a two week period.

Monitoring glucose allows your veterinarian to adjust the insulin dose or change the type of insulin to best regulate your cat. The goals of insulin therapy are (Reference 1):

  • Peak Glucose values of 180-250 mg/dL
  • Nadir Glucose values of 80-144 mg/dL

managing the diabetic cat – emergencies

HYPOGLYCEMIA
Low blood sugar can be life threatening when blood glucose drops to < 40 mg/dL.  You may notice your cat is tired, unresponsive, disoriented and anxious.

What triggers hypoglycemia in the managed feline diabetic?

  • insulin dose is too high relative to food intake
  • too much insulin is given
  • your cat is in remission

If your cat’s glucose in the blood is normal, there is no glucose in the urine, and his fructosamine is in normal range, your veterinarian will start to gradually reduce the insulin dose until insulin is discontinued.  If blood glucose values remain in the normal range and there is no glucose in the urine for 2- 4 weeks once insulin has been stopped, your cat is in remission!

If you suspect low blood sugar…

  1. measure blood glucose (BG)
  2. BG less than 80 mg/dL – feed the cat or give up to 1 tablespoon corn syrup by mouth (1 tbsp = 15 mls – you don’t need to give this all at once)
  3. recheck BG in 15 minutes
  4. if glucose rises, continue to offer food and check glucose until the value is in a normal range
  5. notify your veterinarian
  6. if your cat is unconscious, rub some syrup on his gums or inside his cheek, measure BG, and go the the ER!

DIABETIC KETOACIDOSIS

Diabetic cats have an abnormal glucose metabolism and their bodies may break down fats for energy, resulting in ketones in the bloodstream. Too high a level of ketones makes the blood acidic, causing cells to function abnormally. This is more likely to happen:

  • in newly diagnosed diabetics and poorly regulated diabetics
  • when there are illnesses such as infections, tumors, dental disease (Reference 2)

Watch for…

  • Loss of appetite
  • Lethargy and depression
  • Vomiting/diarrhea
  • dehydration
  • difficulty breathing
  • a sweet smell to the cat’s breath

This is a true emergency – high levels of ketones in the blood and urine combined with the blood and other body fluids becoming acidic can be fatal. Treatment starts with IV fluids to correct dehydration and electrolyte imbalances and administration of insulin to restore glucose as the main source of energy.

Managing the diabetic cat: non-insulin based therapies

Blood glucose curves are part of the recommended monitoring process for cats receiving oral non-insulin therapy but they do not have as important a role as monitoring a cat on insulin.  Cats receiving the oral therapies are not prone to low blood sugar and the blood glucose curve will not have the characteristic shape of a cat receiving insulin. Glucose readings are simply averaged.  It is more important to monitor ketones as these cats may be more prone to develop DKA.

Ketones can be monitored using “urine dipsticks”.  The cat’s urine is collected using non-absorbent litter or a litter tray with a sieve bottom. Urine is collected with a syringe and dropped on the urine test strip (Reference 1).  The makers of Senvelgo, a oral liquid non-insulin drug, recommend checking ketones this way every 1-3 days in the first 14 days of therapy.

Urine dipsticks detect acetoacetic acid and are not very sensitive. Hand-held meters that detect levels of beta-hydroxybutyrate in the blood provide a more sensitive measure of ketones.  Blood can be collected from the ear vein of the cat and level of ketones measured similar to the blood glucose meters described above.  Abott’s Precision Xtra meter has been validated for use in cats (Reference 3).  Perhaps, as  non-insulin therapies become more common, monitoring of ketones in the blood will become part of managing the diabetic cat at home.

With appropriate treatment, the diabetic cat can have a life expectancy similar to cats without diabetes. The key to managing the diabetic cat is early diagnosis, weight control, regular exams and labwork, and home monitoring of clinical signs, glucose and ketones.

references

  1. ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats. Sparkes, A. (chairman), Journal of Feline Medicine and Surgery (2015) 17, 235-250
  2. Rudloff E. Diabetic ketoacidosis in the cat: Recognition and essential treatment. Journal of Feline Medicine and Surgery. 2017;19(11):1167-1174. doi:10.1177/1098612X17735762
  3. Weingart C, Lotz F, Kohn B. Validation of a portable hand-held whole-blood ketone meter for use in cats. Vet Clin Pathol. 2012 Mar;41(1):114-8. doi: 10.1111/j.1939-165X.2011.00389.x. Epub 2012 Jan 17. PMID: 22250845.

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Treating Diabetes in Cats – Insulin and Non-Insulin Therapies

Posted on by felinepurrspective_u3q4o6
Insulin injections can be given under the skin in the loose skin over the shoulders.

Diabetes is a condition where there is persistently high levels of glucose in the blood and urine. In healthy cats, insulin, a hormone produced by the beta cells in the pancreas, signals the cells in the body to take up glucose, reducing the glucose in the blood and urine. Diabetic cats are similar to human Type 2 diabetics –  they are insulin resistant and have beta cells that are not functioning normally. What treatments are available for these cats?

treating diabetes in cats

One way to treat diabetes in cats is to supplement the insulin the cat is still producing with twice daily injections of insulin. There is not a commercially available feline insulin.  Fortunately, production of anti-insulin antibodies does not appear to be a significant problem in cats and we can turn to the synthetic insulins made for the human market or a product derived from pig insulin, developed for dogs (Reference 1).

Practitioners typically reach for the longer-acting insulins listed below to manage feline diabetics (Reference 1)

  • Glargine (brands:Lantus, Basaglar) is given twice daily. It is available in a 100 Units (U)/ml solution. It does not need to mixed before use and should be clear, not cloudy.
  • Protamine Zinc Insulin (PZI) is also given twice daily. It comes in a 40 Units (U)/ml suspension which should be rolled or inverted gently to suspend it before using.

Vetsulin is derived from porcine insulin and has a shorter duration of action compared to glargine and PZI. It is not as well tolerated by cats as glargine and PZI. It should be shaken prior to use and be uniformly white in color. It is available in a 40 Units U/ml suspension.

treating diabetes in cats with insulin

Insulin is given by syringe under the skin (subcutaneously) every 12 hours. It is best to stick to the every 12 hour schedule but if this is not possible, you can administer it within 2 hours before or 2 hours after the 12 hour mark. Skip the dose if you are out of this window (Reference 1).

Insulin Syringes

  • U-100 syringes are used with Glargine insulin.
  • U-40 syringes are used with PZI and Vetsulin.
  • Syringes with 0.5” needles are recommended – shorter needles may not always go far enough through the skin.

Giving Insulin Injections

  • The injection can be given in the loose skin near the shoulder blade or hip.
  • Rotate injection sites to avoid build up of scar tissue and for better absorption of the drug.
  • There are many good videos on giving subcutaneous injections.  Take a look at the “Caring for your Diabetic Cat” video on the “Health Topics” page at Cornell Feline Health Center.
Insulin can be given in the loose skin over the shoulders and hips.

 

Try to make giving injections as pleasant as possible. Establish a routine. It can help to have dedicated place to give treatments, for example, a soft blanket on one side of the sofa. If there is a treat or food your cat likes, be sure to offer this during or after the injection.

 

 

Diet and the Diabetic Cat

Insulin resistance has been linked to obesity in cats. If your diabetic cat is obese, losing weight can help manage his diabetes and possibly reduce his insulin dose.

If your cat has lost weight due to diabetes, start insulin therapy before starting a weight loss program. Once your cat is stable and you have established your “diabetic” routine, implement your weight loss plan (Reference 2).

Plan for weight loss

  1. determine how many calories your cat is eating
  2. reduce current calories by 10-20%
  3. monitor weight and body condition score (BCS)

Diets for Diabetic Cats

  • a high protein, low carbohydrate diet is recommended
  • canned foods are recommended due to their higher water content and lower carbohydrate content
  • many obese cats have low BCS in spite of excess body fat and high protein may be needed to maintain lean body mass

There are therapeutic diets targeted at treating diabetes in cats.  Purina DM and Hill’s m/d  feature high protein and low carbohydrates. If your cat does not care for high protein/low carb diets, consider a high protein, low fat, moderate fiber and moderate carbohydrate diet such as Hill’s w/d food, designed to address glucose balance as well as weight loss and urinary care.

For cats with concurrent diseases, you will have to choose which condition is better treated by diet.  For example, if your cat has kidney disease and diabetes, it may be wise to feed a kidney diet and manage the diabetes by adjusting insulin dose or type of insulin. 

treating diabetes in cats – “non-insulin” therapies

Recently, the FDA approved two drugs given orally for diabetic cats: Bexacat (12/2022) and Senvelgo (8/2023). Bexacat is a  once daily tablet; Senvelgo is a liquid given once daily with food or directly into the cat’s mouth.

Both these drugs (SGLT2 inhibitors) work by blocking the reabsorption of glucose by the kidneys. Instead of being returned to the bloodstream, glucose is excreted in the urine, lowering blood sugar without insulin.  High levels of blood glucose have been tied to beta cell dysfunction – SGLT2 inhibitors lower blood sugar and are thought to promote growth of new beta cells (Reference 3).

These drugs work best for treating diabetes in cats who have been recently diagnosed and have NOT had previous insulin treatment. At this time, Bexacat and Senvelgo are NOT recommended for cats…(Reference 4)

  • 13 years or older
  • with pancreatitis or a history of pancreatitis
  • with kidney disease or other concurrent disease
  • having suffered a condition known as ketoacidosis.

Candidates should be healthy, with the exception of being diabetic (Reference 4).

Treating diabetes in cats has traditionally focused on giving insulin injections and feeding a high protein, low carbohydrate diet. Experts recommend using the long-acting insulins for cats.  The injections are given twice daily.  Recently, new oral  therapies have been made available that offer once-a-day dosing and the potential of regenerating pancreatic cells.

In the next post, we will look at how we can monitor insulin and non-insulin therapies to ensure our diabetic cats’ health and safety.

references

  1. ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats. Sparkes, A. (chairman), Journal of Feline Medicine and Surgery (2015) 17, 235-250
  2. Clark M, Hoenig M. Feline comorbidities: Pathophysiology and management of the obese diabetic cat. Journal of Feline Medicine and Surgery. 2021;23(7):639-648. doi:10.1177/1098612X211021540
  3. (Nakamura A. Effects of Sodium-Glucose Co-Transporter-2 Inhibitors on Pancreatic β-Cell Mass and Function. International Journal of Molecular Sciences. 2022; 23(9):5104. https://doi.org/10.3390/ijms23095104 )
  4. AAHA publications NEWStat® 2023-1 New oral diabetes medication for cats requires careful case selection  Singler, Emily  1/13/23. https://www.aaha.org/publications/newstat/articles/2023-1/new-oral-diabetes-medication-for-cats-requires-careful-case-selection/ viewed 11/23.

 

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