cummings school of veterinary medicine at tufts university

The newsletter for caring owners catnwww.tuftscatnip.comipSeptember 2016 Vol. 24, No. 9 $4

3 Hospice Care for Our It’s not a place — it’s a philosophy of care that turns the focus from cure to comfort. Here’s how it may one day benefit you and your beloved pets.

6 Understanding Feline Hypertension Here’s what you should know about this potentially serious — but usually manageable — disorder that is most commonly seen in older . Our cats suffer from hypertension, too ... 6 8 How to Recognize and Manage Pain Cats will typically try to conceal an injury or an illness, but there are ways for an owner to recognize that a prompt veterinary consultation is in order. Here’s how.

11 When You Need to Rehome a Cat When you love cats, it may feel like, “The more, the merrier!” But unfortunately, there are times when the feline dynamic just doesn’t work. Here’s some help. Also in this issue: When cats simply can’t get along ...... 11 2 Editor’s Note One step at a time: Sometimes, we have to consider what’s best for our cats before we rush to make big decisions.

14 Dear Doctor Unfortunately, little is known about whether or not certain supplements actually benefit our cats. 16 Short Takes Our pets are living longer and healthier lives, but there remains a lack of research on what actually constitutes Understanding healthy aging ...... 16 healthy aging.

1609_CN_Sept2016.indd 1 7/27/16 3:33 PM 2 editor’s note The newsletter for One Step at a Time caring cat owners Editor in Chief: John Berg, DVM, DACVS

Sometimes, we have to consider what’s best Executive Editor: Elizabeth Vecsi September 2016

for our cats before we make big decisions. Editorial Board: his summer, I witnessed the important to check out future Stephanie Born-Weils, DVM — Behavior

catnip Lluis Ferrer, DVM, PhD, DECVD — Dermatology happy adoption of adorable homes, and giving away animals Cailin Heinze, VMD, DACVN — Nutrition | into families living for “free” is never a good idea Mary Labato, DVM, DACVIM — Internal Medicine T in my neighborhood — a couple unless you know and trust the Armelle de Laforcade, DVM, DACVECC — of brown tabby siblings born to people well). Emergency and Critical Care a feral mother, and another few And while it’s good to be a Deborah Linder, DVM, DACVN — Nutrition William Rosenblad, DVM — Dentistry adopted from a local animal shel- person that your animal-loving Elizabeth Rozanski, DVM, MS, DACVECC — ter. friends quickly turn to in times Emergency and Critical Care Nothing is quite as fun as a of trouble, don’t be the one who Michael Stone, DVM, DACVIM — Internal bundle of kittens. The idea cer- can’t say “no.” Taking in an end - Medicine tainly tempts me in certain ways less stream of needy animals isn’t www.tuftscatnip.com — but I quickly realize that adding doing your household any favors, customer service E-mail: [email protected] any new four-legged members to either. The article on page 11 of Online: www.tuftscatnip.com our established family is likely an this issue is a great resource if you SUBSCRIPTION QUESTIONS idea relished only by me. My three — or a person you know — is expe- Phone: 800-829-0926 middle-aged cats are happy right riencing the emotional strain of Mail: Catnip now. The status quo is just fine by needing to rehome a . PO Box 8517, Big Sandy, TX 75755-8517 Subscriptions: $39 per year (US) them, and our article this month Another topic to share that Digital only: $20 per year (US) on rehoming cats was a perfect may not apply to your life as a pet Editorial correspondence reminder. owner right now — but may be Email: [email protected] I was in that position once, exactly the type of advice a friend Letters: Catnip many years ago, and bringing a needs — is the growing popularity PO Box 5656, Norwalk, CT 06856-5656 Permissions: Jennifer Jimolka cat into one’s home — only to real- of hospice care for pets. When you 203-857-3144 ize a month or two later that the reach a point where there is no

“fit” was a very, very bad one — is cure for a serious disease or illness, Catnip™ (ISSN no.1069-6687, U6SPS No. 0010-381) is a painful experience. There’s a lot yet your beloved pet is not quite published monthly by Tufts University and managed of guilt swirling around, upset for ready for euthanasia, there is now by Belvoir Media Group, LLC, 535 Connecticut Ave., Norwalk, CT 06854. Copyright 2016, Tufts University. all cats involved, and it basically an in-between time where you can All rights reserved. Reproduction in whole or part is taught me that there has to be an focus on gentle care, comfort and strictly prohibited without the publisher’s written per- emergency plan in place if things quality of life. mission. Printed in the US. CAN Publishing Agreement #:40739143. prove to be impossible. Because it’s It wasn’t so long ago that the not really helping to save the life of idea of providing such care for our Postmaster: Send address changes to Catnip, PO Box 8517, Big Sandy, TX 75755-8517. one cat if it makes the lives of you pets would be considered implau- and your other cats completely sible. Let’s be thankful that we are Purpose: The goal of Catnip is to present feline medical and behavioral information. Catnip is not intended miserable. Which it truly did. living in a more understanding to be a diagnostic service for individual cats. Readers So if you ever find yourself in and kind world as far as animals should always consult qualified health care provid- that position, please realize that are concerned. Yes, we have a long, ers for specific diagnosis and treatment. Further, you’re not alone. Sometimes, long way to go! But we are mak- Catnip does not assume any legal responsibility. Recommendations of products or services are made we make decisions that come ing strides, nevertheless. I am sure solely by the editorial staff for the convenience of our from a very good place without that the readership of Catnip rep- readers. being able to anticipate the ulti- resents the very best of the animal Catnip accepts no advertising. All submitted letters and mate outcome. Luckily, there are lovers out there who are trying to photographs become the property of Catnip. increasingly more ways for us make a difference. Mailing Lists: We occasionally make our subscriber to stay connected and branch names available to carefully screened organizations out via social media when we whose publications and services July interest our read- ers. If you’d rather not receive such mailings, please need help with our animal crises Elizabeth Vecsi write to us at the address shown above and enclose (just remember, though: It’s very Executive Editor your mailing label.

1609_CN_Sept2016.indd 2 7/27/16 3:33 PM noteworthy 3 Hospice Care for Our Pets September 2016

It’s not a place — it’s a philosophy of care that turns the focus from cure to comfort. Here’s how it may one day benefit you and your beloved pets. catnip |

n today’s culture, pets are commonly considered to be Ibeloved family members, and the decisions we make regarding their care often reflect our own philosophical views regarding nutrition, emotional well-being and healthcare. With improved nutrition and medical advances, www.tuftscatnip.com our pets are living longer, health- ier lives — and receiving the type of care once thought out of reach for animals. While these medical advance- ments certainly give us hope, they also raise a number of decisions we must make on behalf of a beloved pet regarding a thoughtful, com- passionate end-of-life plan. Until recently, pet owners primarily had two choices for terminally ill pets: expensive, aggressive treat- ment or euthanasia. Now there’s another choice that bridges the gap between treatment and euthana- sia — hospice care.

What is hospice care? It’s important to realize that hos- pice is not a place; it’s a philoso-

phy of care that turns the focus Photo coursey of I ngrid A H EL P Project from cure to comfort and providing Caregiver Tom Lawrence assisting hospice house call veterinarian, Dr. Tina Ellenbogen, with a quality of life exam for Gabby. improved quality of life for patients in the last stages of an incurable hospice philosophy and, as a field, for veterinarians regarding hos- disease. Palliative and medical is new and rapidly growing in pice care is the concept of how to care, which can be provided at any demand as pet owners increasingly talk to owners about discontinuing point during an illness, can help to seek hospice and palliative care for chemotherapy, treatment, X-rays relieve pain, symptoms and stress their pets giving them not only a or ultrasounds. That your cat’s can- from a serious illness. “good death” — but more impor- cer has not been adequately con- Both use an interdisciplinary tantly, giving them a good life until trolled and that continuing those team that offers emotional, physi- their death. In other words, it’s not things merely causes your cat more cal and spiritual support for the about prolonging life, but enhanc- pain and distress; that it’s time to patient and family members. Ani- ing the life that’s left. just focus on the quality of time mal hospice mirrors the human “Currently, the biggest challenge continued on next page

1609_CN_Sept2016.indd 3 7/27/16 3:33 PM 4 left right now, no more thinking about how to extend life,” explains pain medicine specialist Alicia M. Karas, DVM, MS, DACVAA, an assis- tant professor at Tufts Cummings School of Veterinary Medicine. “I September 2016

believe that if you could ask your cat, ‘Do you want to continue treat- ment because you might live for catnip three more months?’ the answer | would be ‘No.’”

Hospice considerations The first step to hospice care is rec- ognizing that the patient is in the last phase of life. This is emotion- ally difficult for the veterinarian and pet owner alike, and it needs to be discussed with sensitivity. Often www.tuftscatnip.com when we think of end-of-life, we think of geriatric pets — but that’s not the only time hospice would be considered. “Certain diseases and medi- cal conditions that warrant hos- pice care can include cancer, organ failure (kidneys, liver and heart), general slowing down, a recom- Photo coursey of I ngrid and T om L awrence Caregiver Tom Lawrence enjoying some time with his cat, Gabby. mendation for interventions like surgery that are unacceptable to your pet, you will be an integral think owners are always aware of the family’s wishes or any life- part of the hospice triad along with the amount of suffering that pets limiting condition that contributes your veterinarian. The heart of the goes through. Nausea can be a really to an excessive burden of caregiv- triad is the patient, and physical potent and distressing thing that’s ing for a family,” explains Michelle comfort is paramount. “Preparing hard to live with; difficulty breath- Nichols, MS, Executive Director to care for your aging, ill or dying ing; helplessness, etc. and Co-founder of Animal Hospice, pet is similar to caring for a child or “If the cat can no longer, or barely, End-of-Life and Palliative Care Proj- older adult. You would take time to respond to humans, or responds ect (AHELP) in Seattle and board learn about your loved one’s condi- with anger because all they can member of the International Asso- tion and ways to ensure the high- think of is what’s happening in ciation of Animal Hospice and Pal- est degree of comfort possible. You their own body, then it’s time for liative Care (IAAHPC). would learn how to monitor your very drastic measures. That would The length of hospice care has loved one’s quality of life, and then include very strong pain manage- many variables, including fac- regularly communicate his or her ment, very strong anti-nausea tors specific to the individual pet condition with the hospice team,” management or even euthanasia,” and his or her medical condi- describes Nichols. continues Dr. Karas. tions. It could last for days, weeks It’s during this time that you or months, and sometimes years Take on some responsibilities can start making aftercare plans. with certain chronic conditions. Dr. Karas explains that some of There are many considerations The decision to stop treatment and the responsibilities include learn- that include cremation, burial and provide hospice is a deeply per- ing how to safely administer medi- memorialization, as well as mak- sonal decision based the individual cations and subcutaneous fluids, ing emotional preparations for the pet’s overall circumstance, the fam- and how to recognize signs of pain final goodbye. It is better to decide ily’s personal beliefs, budget and (see related article on page 8 of this earlier than confront the decisions schedule. issue). She emphasizes, “It’s actu- later when emotions are running If you choose hospice care for ally more than just pain — I don’t especially high.

1609_CN_Sept2016.indd 4 7/27/16 3:33 PM The team approach sitters skilled in senior care are Historically, many veterinar- 5 The veterinarian acts as the medi- important logistically, and veteri- ians have been practicing hospice cal director of the hospice team, nary technicians who come to the and palliative care to alleviate pain, and medical treatment must be home to nurse the animal patient, suffering and discomfort. Until done on the order of a veterinarian. and/or teach and assist the fam - recently, it hasn’t formally been This may be your own veterinarian, ily to do so themselves are ideal,” given a name. As more pet own- September 2016

a hospice-focused veterinarian, or explains Nichols. ers become aware of other options the two of them working together. “As our animals’ life energy besides curing or euthanizing a Not all veterinarians are equipped diminishes, the gentler, alterna- beloved pet, veterinary hospice to offer the full spectrum of hospice tive therapies can be extremely services are becoming increasingly catnip care services, so it is appropriate effective in preserving quality of more common. |

to refer out to a veterinarian who life. Other team members’ services Educating pet owners of more offers hospice services. that can contribute to comfort for modern options can help when it Notably, both Nichols and Dr. both the animal and the family comes to making difficult end-of- Karas explain that veterinarians are are: massage and bodywork, aro- life decisions for pets that honor not currently taught about hospice matherapy, energy work, acupres- the human-animal bond with com- care in veterinary programs. Yet, sure, flower essences and music passion, grace and dignity. — there are veterinarians choosing the therapy.” Ramona Marek, MS, Ed special niche that requires a particu- lar grace and skilled expertise. There www.tuftscatnip.com are goals, guidelines and policies Information Resources for Readers established by the American Vet- erinary Medical Association (AVMA), The concept of hospice care for pets is a relatively new field, and it’s expe- the American Association of Feline riencing a meteoric rise as more and more pet owners seek an alternative Practitioners (AAFP) and IAAHPC for animal hospice services that can away from cure or early euthanasia to focus on a quality end-of-life. Even be provided, but currently there is though the number of veterinary hospice practices is increasing — and a shortage of qualified hospice and palliative care providers. many are mobile — the flip side is that people aren’t yet aware of them or

What to look for are confused about the services they offer. “When interviewing a hospice- focused veterinarian, you should ask Here’s a list of resources to learn more about animal hospice care. To find what training, education and expe- a hospice-focused veterinarian team and services in your area, search the rience he or she has had in end-of- life care,” says Nichols. “Performing online resources listed below. home euthanasia is just one service offered by a hospice focused veteri- ■■ Animal Hospice, End-of-Life and Palliative Care Project (AHELP) (in Seat- narian, so ask what else they offer.” tle) — www.ahelpproject.org Some complementary veterinary services considered to be potentially ■■ The International Association of Animal Hospice and Palliative Care appropriate include acupuncture, Traditional Chinese Medicine and (IAAHPC) — www.iaahpc.org herbs. Remember, hospice care extends ■■ Lap of Love — www.lapoflove.com/Services/Veterinary-Hospice help to the caregiver and family, plus the hospice team has to be ■■ The American Association of Feline Practitioners — well coordinated and have good communication. www.catvets.com/public/PDFs/PositionStatements/HospiceCare.pdf “Best practices speak to the ■ need for emotional and spiritual ■ The American Veterinary Medical Association (AVMA) — ‘care for the caregiver’ so that families can find benefit from www.avma.org/KB/Policies/Pages/Guidelines-for-Veterinary-Hospice- mental health professionals, chap- Care.aspx lains and spiritual counselors. Pet

1609_CN_Sept2016.indd 5 7/27/16 3:33 PM 6 health

Understanding Feline Hypertension September 2016

Here’s what you should know about this potentially serious — but usually catnip manageable — disorder that is most commonly seen in older cats. |

s a cat reaches the age of eight or nine — the feline Aequivalent of age 40 or 50 in a human being — he is likely to begin experiencing signs of one or more age-related physical dis- orders. If unnoticed or untreated, www.tuftscatnip.com such disorders are likely to inten- sify over time and may eventually prove lethal. Hypertension (abnormally high blood pressure) is one of these dis- orders. Without treatment, it can potentially lead to blindness and even fatal damage to the heart, kid- neys and brain. Fortunately, if diag- nosed at an early stage and treated appropriately, hypertension can be a manageable feline disease condition.

Primary hypertension In rare cases, a cat’s elevated blood pressure has no discernible cause.

This is known as primary — or © I an A llenden | D reamstime.com essential — hypertension, accord- Hypertension — abnormally high blood pressure — can potentially lead to blindess and serious damage to the heart, kidneys and brain. ing to Arnold Plotnick, DVM, the owner of Manhattan Cat medications to raise a cat’s blood Complex factors converge Specialists, a feline-exclusive veter- pressure. Although fear, anxiety Several complex factors can result inary hospital in New York City. “It or sudden physical trauma may in the development of kidney- just happens, and we don’t know cause a spike in an animal’s blood related feline hypertension. For why,” he says. pressure, random occurrences such example, the kidneys are respon- On the other hand, veterinari- as these have not been linked to sible for maintaining the proper ans frequently diagnose secondary chronic feline hypertension. amounts of fluid and salt in the hypertension, which is a conse - In the great majority of cases, Dr. body. They also produce hormones quence or byproduct of a separate Plotnick points out, feline hyper- that help regulate blood pressure. physical disorder. Occasionally, for tension is a consequence of either But diseased kidneys often pro- example, the condition can stem chronic kidney disease (CKD) or duce abnormal amounts of these from the presence of a heart dis- hyperthyroidism. And of those hormones, or they inappropriately order or a tumor that is producing two conditions, kidney disease is retain salt and water. excessive amounts of certain hor- seen significantly more often. (See The resulting fluid retention mones, such as epinephrine. related article on earlier diagnosis leads to congestion in the circula- It’s also possible for some of CKD in Catnip, August 2016.) tory system and, in turn, a buildup

1609_CN_Sept2016.indd 6 7/27/16 3:33 PM of pressure in the arteries. This is The way it’s recorded 7 especially problematic, he notes, in In almost all cases, Blood pressure is recorded in cats older cats. the same way as it is in humans. In hyperthyroidism, there is an That is, two values are taken into overproduction of thyroid hormone two relatively non- account: the higher one being the and a resulting elevation of an ani- blood pressure in the arteries that September 2016 mal’s metabolic rate. Due to this invasive methods is recorded when the heart beats acceleration, the heart beats faster (systolic pressure), the lower when and more forcefully. This phenom- the heart rests between beats (dia- will be used to catnip enon — referred to as “excessive stolic pressure). cardiac performance” — results For humans, these two values |

in increased pumping pressure, measure a cat’s blood are written one over the other, greater output of blood into the separated by a slash mark. (Nor - arteries and sometimes a corre- pressure: the Doppler mal human blood pressure is sponding rise in blood pressure. An 120/80 mm Hg, which stands for estimated 25 percent of cats with millimeters of mercury). For cats, hyperthyroidism have high blood or the oscillometric says Dr. Plotnick, a normal reading pressure. would be 160/100. In addition to chronic kidney technique. Anything above either of those disease and thyroid gland hyper- numbers would be considered www.tuftscatnip.com activity, says Dr. Plotnick, feline suggest high blood pressure. Gen- high blood pressure. If a cat is hypertension can be caused by eral malaise and poor appetite, for diagnosed with hypertension cancer of the adrenal gland. “An example, are signs of various condi- using one of these techniques, adrenal tumor secretes a hormone tions. In order to arrive at a diagno- other tests will be done to identify called aldosterone,” he notes, sis, it is essential that an animal’s the cause — complete bloodwork, “which causes a rise in circulating blood pressure be measured in an for example. sodium. And this will result in ele- appropriately equipped veterinary vated blood pressure.” facility. In extremely rare cases, How its treated says Dr. Plotnick, the blood pressure Primary treatment for feline hyper- It is indirectly age-related will be measured by placing a cath- tension, according to Dr. Plotnick, There is no recognizable predis- eter directly into a cat’s artery. In currently centers on classes of posal for high blood pressure in almost all cases, however, either of drugs including calcium channel terms of gender, he notes. On the two less invasive methods will be blockers and angiotensin-convert- other hand, he points out, “Most employed: the Doppler technique ing enzyme (ACE) inhibitors, both cats with kidney disease, hyperthy- or the oscillometric technique. of which work to reduce blood roidism or adrenal tumors are older ■■ Doppler technique: This tech- pressure by relaxing and dilat - — so hypertension is indirectly nique involves placing a small ing an animal’s blood vessels. “My age-related.” ultrasound probe over one of the drug of choice for treatment in cats Cats with either advanced pri- large arteries, usually in a cat’s is amlodipine, a calcium channel mary or secondary hypertension tail. An amplifier connected to blocker that is given once a day,” will exhibit problems associated the probe produces audible says Dr. Plotnick. “It is very effec- with the systems that are typically sounds for every pulse beat. A tive in cats.” affected by the condition: the ocu- blood pressure cuff is placed just At the same time, Dr. Plotnick lar system (sudden blindness or above the probe and is inflated points out that amlodipine or retinal hemorrhaging); the renal until the pulse sounds can no lon- other prescribed medications system (poor appetite, weight loss, ger be heard. The cuff is then must be given consistently increased drinking and urination); slowly deflated, and the pressure throughout an affected cat’s life- the neurologic system (seizures, at which the sound of the pulse time, although dosage may be disorientation); and the cardiovas- can be heard consistently is the altered depending on fluctuations cular system (fluid retention, diffi- systolic arterial blood pressure. in the patient’s blood pressure. He culty in breathing). ■■ Oscillometric technique: This advises that an affected cat’s blood The clinical signs of systemic method utilizes a cuff containing pressure should be measured hypertension are often vague and a small sensor that detects small every three months or so, and the nonspecific, except for the ocular oscillations in an artery with medication dosage be adjusted and neurologic problems that may each pulse. accordingly. — Tom Ewing

1609_CN_Sept2016.indd 7 7/27/16 3:33 PM 8 health Recognize and Manage Feline Pain September 2016

Cats will typically try to conceal an injury or an illness, but there are ways for an owner to recognize that a pet needs some assistance. Here’s how. catnip

| tub your toe, bump your

head or cut your thumb Swhile peeling an apple, and you’re apt to give out a yell that will clearly indicate you’re in pain. And then you might spend the next hour or two discussing the incident, lamenting it and seeking the solace of those who are near www.tuftscatnip.com and dear to you. When it comes to dealing with pain, however, our cats aren’t like that. Eons of experience in the wild have taught cats to conceal any sort of physical disability as best as they can from potential enemies. A part of their natural survival instinct is to hide the fact that they have been injured or otherwise weakened, which could render them susceptible to attack by a predator. “Because cats cannot speak for

themselves,” says Michael Stone, © L inqong | D reamstime.com DVM, a clinical professor of small Withdrawal from company and the avoidance of brightly-lit areas are two signs that your cat is experiencing pain. animal medicine at Tufts, “own- ers must look for signs of pain that changes such as a decline in groom- Stone: “You can assume that your they might be exhibiting. And ing, a tendency to hide and an cat might be experiencing pain then the owners must act as their abnormal sensitivity to normal han- — even if he’s not exhibiting dra- cats’ advocates.” dling.” Other possible signs include matic behavioral signs — if you soiling outside the litter box, aggres- notice him withdrawing from nor- Observation is key sion when approached, unusual mal activity, showing lameness, How can an owner tell whether a posture, uncharacteristic vocaliza- or having difficulty jumping onto cat is suffering pain in his bones, tion, an altered sleep pattern and or off of elevated surfaces.” joints, ligaments, muscles or inter- reduced appetite. nal organs? According to Dr. Stone, Although these behaviors — A veterinary exam is in order “Observing a cat’s behavior is the and many others as well — may If an owner observes any such most accurate method of evaluating be prompted by pain, they may indicators of pain, the affected cat his pain. An owner should note both also be exhibited by healthy, should be examined by a veterinar- the absence of normal activities and happy cats that are free of physi- ian. Although behavioral signs may the development of new behaviors cal discomfort. Consequently, the be more telling than physiologic that may emerge as a response to signs should be considered by an signs, a veterinarian will examine pain. animal’s owners in the context of the cat for such potential indicators If a cat is experiencing pain, the what is normal for that individual of a significant disorder as abnor- owner is apt to notice behavioral cat. At the same time, says Dr. mal heartbeat, body temperature,

1609_CN_Sept2016.indd 8 7/27/16 3:33 PM respiratory rate and blood pressure, a joint, for example) — transmit Pain can also be categorized as 9 as well as an elevated level of cer- electrical impulses along nerves visceral, neuropathic or muscu- tain stress hormones in the patient’s to the spinal cord and then to the loskeletal. “Visceral pain means blood. The veterinarian is also likely cat’s brain. that it is deep within the body,” to ask the owner about such details In some situations, the initial says Dr. Stone. “The discomfort of the patient’s routine activities as five or 10 minutes of pain can be might stem from, for example, September 2016

the cat’s typical eating and groom- life-saving, due to increased car- intestinal upset or pancreatitis. ing habits, his normal sleep pat- diovascular output, certain muscle Neuropathic pain originates from terns, the use of his litter box and reactions and the triggering of the direct nerve involvement, result- the way he typically interacts with fight-or-flight instinct that will ing from trauma to the head, say, catnip his owners and other animals in the prompt a cat to escape from the or a slipped vertebral disc. And |

household. source of the pain. But if the pain musculoskeletal pain can result persists for an appreciable length from such problems as a sprain, a Pain serves a purpose of time, or occurs without a read- muscle strain, or arthritis.” Unpleasant as it is, pain can play ily identifiable cause, it will serve an important role in maintaining no positive purpose. During the examination a cat’s well-being by alerting her “I will use gentle manipulation to brain to the fact that something, Types of pain assess a cat’s reluctance to hav- somewhere in her body, has gone Dr. Stone notes that feline pain, like ing a particular area touched,” says awry and needs attention. Pain is human pain, can be acute (or adap- Dr. Stone. “Some animals are more www.tuftscatnip.com a protective mechanism, enabled tive) — the kind of intense but com- stoic than others. Some are more by sensitive receptor cells located paratively short-term discomfort timid. I try to integrate my findings throughout the body — in the skin, that may be caused, for example, by with what the owner is noticing at the bones, joint surfaces, artery a bite wound or surgical incision. Or home.” walls, just about everywhere. it can be chronic (or maladaptive), What methods and pharmaceu- These specialized cells — which persisting constantly or intermit- ticals will a veterinarian typically are stimulated by harmful forces tently for an extended period as a use or suggest for the treatment of or substances (pressure on a limb gradually intensifying consequence feline pain? “Drugs, physical ther- or internal organ, extreme heat or of an injury or long-standing physi- apy, cold or heat treatment, ultra- cold, the consumption of a poison- cal disorder, such as severe dental sound and dietary adjustment ous substance, inflammation in disease or arthritis. continued on next page

The Most Common Signs of Pain In an effort to identify the most common signs of feline pain, a team of animal behaviorists in Great Britain conducted a year-long series of in-depth interviews with 19 veterinary experts. According to the researchers’ findings — pub- lished in February 2016 in the scientific journal PLoS ONE — the signs listed below are considered to be the most reli- able pain indicators. The most prominent signs include the avoidance of brightly lit areas, growling, changes in feed- ing behavior, closed eyes and groaning. ■■ Absence of grooming ■■ Closed eyes ■■ Reluctance to move ■■ Frequent shifting of weight ■■ Abnormal gait ■■ Dislike of palpation/petting ■■ Difficulty in jumping ■■ Lowered head posture ■■ Frequent licking of a specific body region ■■ Frequent and involuntary blinking ■■ Withdrawal from company ■■ Change of behavior while feeding ■ ■■ Hiding ■ Reluctance to play ■■ Groaning, growling ■■ Avoidance of brightly-lit areas ■■ Hunched-up posture ■■ Decrease in appetite ■■ Straining to urinate ■■ Overall decrease in activity ■■ Tail twitching ■■ Decrease in rubbing against people

1609_CN_Sept2016.indd 9 7/27/16 3:33 PM 10 therapy for weight control might be used,” says Dr. Stone, “as well Experts Find New Ways to Assess Pain as resolution of a specific under- A modern concept lying problem, such as removal of used in recogniz- a painful growth. Each cat’s treat- ing and assessing ment will be individualized.” acute pain in cats September 2016

Two types of analgesics is the use of a facial Currently, feline pain is treated pri- pain expression catnip marily with two types of analgesics: scale, modeled | opioids, which function as numb- after the neonatal

ing agents that dull pain; and non- facial scales which steroidal anti-inflammatory drugs shows the changes (NSAIDs), which reduce inflam- in a baby’s facial mation. A veterinarian will select expression from a painkiller that is appropriate, depending largely on the source of happy to painful. the pain, the intensity of a cat’s dis- According to comfort, and the length of time that Alicia Karas, DVM, www.tuftscatnip.com is prudent and desirable for an ani- MS, DACVAA, pain

mal to be given the drug. medicine specialist © Jdgrant | D reamstime.com Owners must be aware that and assistant professor at Tufts University Cummings School of Veterinary some pain-relieving medications Medicine, pain researchers designed similar scales for mice and rats, and that have been formulated for have now done the same for cats. According to the study, areas that showed humans (such as Tylenol) could be fatal to a cat and must never be used differences between painful and pain-free cats are the eyes, ears, mouth and to treat feline pain. In fact, no pain- muzzle. killer should be given to a cat unless Caricatures of the expressions were drawn based on the mathematical the medication has been specifi- differences and distances between the anatomical points to compare pain- cally prescribed by a veterinarian, free and painful cats — for example, changes in the whiskers and ears as well and that you have been instructed as nose and cheek flattening. The study is the first to specifically show how on how and when to administer it. facial features can be used to differentiate between pain-free and painful Medications for can sometimes cats, and could potentially become a viable tool for assessing acute pain in be dangerous for cats, as well. cats. Multimodality treatment Another tool for assessing pain in cats is the Composite Measure Pain Regarding current progress in the Scale — Feline (CMPS-F). This scale assesses behavioral changes in six cat- treatment of feline pain, he adds: egories that include: vocalization, posture, attention to a wound, response “Longer-lasting pain medications to touch and response to people. Each category is scored for a total possible have recently become available; score of 16. For a score of four or higher, intervention with pain medication is the use of acupuncture is becom- recommended. However, further studies are needed for universal validation. ing more common as well. Overall, Other acute pain scales include the Colorado State University Feline multimodality treatments, which Acute Pain Scale and the UNESP-Botucatu Multidemsional Composite Pain use a combination of drugs and techniques, have become the new Scale. An example of a pain scale can be found at ivapm.org/for-the-public/ approach to pain control.” animals-and-pain-articles/how-we-assess-your-felines-pain-level/. — Ramo- Dr. Stone advises owners never na Marek, MS, Ed to ignore clear indications that a cat may be experiencing sud- discomfort; in that case, a routine at-home treatment by her owner, a den-onset, acute pain; veterinary veterinary checkup could reveal cat’s acute or chronic pain can be consultation should be pursued the presence of osteoarthritis or significantly reduced, emphasizes without delay. Owners should some other source of persistent Dr. Stone. Indeed, he says, “Feline also be aware that a cat with long- pain. pain can be lessened with appro- lasting chronic pain may develop The good news is that with priate care in almost every situa- coping strategies for concealing proper veterinary care and tion.” — Tom Ewing

1609_CN_Sept2016.indd 10 7/27/16 3:33 PM welfare 11 When You Need to Rehome a Cat September 2016 When you love cats, it may feel like, “The more, the merrier!” But unfortunately, there are times when the feline dynamic just doesn’t work. Here’s some help. catnip |

certain amount of conflict and discord is natural in A any group living situation. Owners of even the most mellow and congenial cat families know just how quickly conflict can erupt as group members experience the nor- mal ups and downs of life. Wise owners understand how www.tuftscatnip.com powerfully even seemingly insig- nificant changes can affect their cats and disrupt the group’s harmony. They also know how important it is to address the effects of changes positively and immediately, before the situation spins out of control. Some of the trickiest situations to manage are those when a new family member enters the picture, and when a family member leaves

the group. Loss of a human or feline © Pnsj88 | D reamstime.com family member — especially a sud- To a cat, an unfamiliar animal is not necessarily a potential friend, but a possible threat to prized resources. These can include food, territory and attention from us. den loss — can trigger a cascade of alterations in the group’s structure, without a hitch. But difficult intro- introductions, if carried out reli- upset existing relationships, or even ductions, more than any other giously, should work most of the bring to light previously hidden household change, are what can, time,” says Nicholas Dodman, BVMS, conflicts. too often, bring the cat owner’s most Professor Emeritus at the Tufts dreaded word — rehoming — into Cummings School of Veterinary Be prepared for anything the conversation. Medicine. Life is full of surprises, and even the Why does introducing a new cat most prescient owner cannot antici- to a group so often cause such con- The best laid plans pate how a loss or change in the sternation? To a cat, an unfamil - But sometimes, even when an group’s composition will affect his iar cat is not a potential friend but owner does everything right, some cats and their relationships. With a possible threat, in a way that a or all of the cats refuse to go along cats, though, it’s always best to be member of any other species is not. with the program. “Cats, like people, prepared for just about anything: A Cats see other cats as direct competi- have different personalities,” says minor change might cause a major tors for the resources they prize the Dr. Dodman. Sometimes it’s the new upset, while something human fam- most, such as food, space (territory), cat who just refuses to fit in and get ily members see as monumental social status and attention from along; other times one or more of hurricane might pass through the favorite humans. the resident cats make it abundantly cat group like a spring breeze. Wise cat owners know how to clear that they have no intention of So it is with introductions. Many manage feline introductions to accepting the newcomer as a family introductions — whether of kit- maximize their chances of suc- member — ever. tens or adult cats — simply go off cess. “The ‘yellow’ brick road’ of cat continued on next page

1609_CN_Sept2016.indd 11 7/27/16 3:33 PM 12 “Maybe the cats are incompat- comfortable with the shelter, and If a single-cat home isn’t avail- ible, personality wise. No matter feel that the cat has a good chance able, notes Dodman, tread carefully. how slowly you go, you still see ears of finding a more suitable home “If they have cats, propose a ‘trial flat back, dilated pupils, hissing, through them, this can be a comfort- marriage.’ Put all the cats in crates, and charging — all the hallmarks of able option. put them together in a room and angry cats.” One caution, though: Unless see how they react. If you see inter- September 2016

you’re quite sure that the newcom- est and curiosity, that’s a good sign The domino effect er’s own particular quirks were the — proceed with your introductions. Weeks and months go by and the cause of his failure to be accepted But if you immediately see hostility, catnip fur continues to fly. If you continue by your cats, resist the urge to take spitting, etc, — well, you don’t want | to press the point, the situation another cat home to “try again.” It to start on the bottom of that ladder

can deteriorate badly: Previously might be better to wait awhile, and again!” mellow cats are snarling. Friendly think more deeply about whether cats are now hiding under the bed. you and your cats are ready for any Helping a friend or relative Former friends refuse to cuddle. And new addition. It may be that try- If more than a few people know you someone is missing the litter box ing to adopt one more cat put your love cats, you’ve probably received more often than not. If the situation home past its natural cat-carrying many phone calls like this: A friend has deteriorated to that extent, it’s capacity. of a friend of an acquaintance has a time to back up and reassess before If neither a breeder nor a shel- cat (or two or three) who need new www.tuftscatnip.com the group’s harmony is totally ter return is an option for you, your homes immediately — by this week- destroyed. task becomes much more diffi- end! The owner has exhausted all No matter how much you want cult. Now you need to turn to your her options, she’s at wit’s end — and the introduction to work, at some friends, family, social networks, and now you are the cats’ only chance. point, it may not be worth put- other like-minded contacts. Find- The only alternative is a crowded ting all your cats under that much ing a home for a cat through these municipal shelter — and you know continuing stress. That’s when channels can be a difficult, lengthy what that means for the cats. This is thoughts of rehoming start to assert process, calling for diplomacy, a very difficult situation that imme- themselves for some people. Here’s tact, transparency, honesty and diately produces, in any caring cat some help in making this difficult understanding. lover, an almost overwhelming decision. There are always lots of cats seek- sense of guilt and obligation. ing homes, and many questions Although your first instinct is Deciding to Rehome — sometimes uncomfortable ques- probably to take the cats, think it If all else has truly failed, and you’re tions — will doubtless be raised. through very carefully. What do you unable or unwilling to compartmen- Your motives, your commitment to know about the cats and their his- talize your home and/or break up cats and even your character may tory? Do they have any special med- your cat group, you may be forced to be called into question. You need to ical needs? Behavioral issues? How conclude that finding a suitable new tread a fine line between generat- will taking on the burden of one home for the cat is the kindest and ing feelings of guilt and obligation in or more additional cats affect your most sensible path forward. others, and doing the right thing for own cat group? Is your own home If you obtained the newcomer the cat. You need to paint the cat in already at its maximum cat-carrying from a breeder, that breeder should the best possible light, while being capacity? be the first person you turn to. Many absolutely honest about any per- And — most importantly — has breeder contracts require that the sonality, medical or behavior issues the owner truly exhausted all alter- breeder be notified if you can’t keep involved. natives? I’ve found that by asking a the cat for any reason, and that they few gentle, but pointed, questions, be given the opportunity to take the Single-cat status can help I can almost always determine that cat back. It may be best to seek out a new the owner has indeed not exhausted If you adopted the newcomer home where the cat will be an only all the other alternatives available from a shelter, you might choose cat. “If the cat is going to a home to her. That’s when I’m ready to sug- to ask the shelter if they’d be will- with no other cats, your only task is gest several other options, such as ing to take the cat back. Obviously, to vet the people, in the same way looking into temporary boarding, a lot depends on the particular shel- you would judge a daycare for your widening the search for a new home ter, their management practices child,” explains Dr. Dodman. “Make to friends and relatives she may and philosophies, and how you sure they’re decent people who will not have considered, and contact- feel about the shelter. But if you’re take good care of the cat.” ing local, privately-run shelters and

1609_CN_Sept2016.indd 12 7/27/16 3:33 PM sanctuaries that may be willing and 13 able to take in the cats in return for a generous donation. Whatever you do, don’t just impulsively agree to take the cats in yourself. If you become known September 2016

as someone who does this, your reward will likely be more cats who need homes by this weekend! Think through the problem, make sugges- catnip tions and stand ready to help — but |

don’t be a pushover. But what if it’s dear Aunt Tilly’s beloved pets — cats you’ve known for years — who need a new home, or the cats of a close friend who has had a sudden run of extremely bad luck? In this case, your feel- ings of obligation and guilt can run immeasurably higher. Again, think www.tuftscatnip.com carefully about the ramifications of taking in the cats yourself. You’ll know if it’s the right thing to do,

both for the cats and for yourself. © R amonespelt | D reamstime.com If you conclude that you’re just If you’re known as a compassionate animal lover, you may be called into service if unable to make a lifetime commit- the people around you ever need to rehome their pets. ment to those cats in addition to the But the supply of cats needing A regular volunteer commitment, commitments you’ve made to your new homes is endless, and these plus regular donations of money own cats, be honest about it. Explain outfits, too often, soon find them- and needed supplies, will go a long your rationale, and explain how it selves in over their heads. Some of way towards helping insure that the would not be the best thing for the them have blown up scandalously shelter will welcome any cats you cats. Then step up to the plate. and very publicly, after revelations absolutely need to place. that the cats were living in atrocious How to network conditions and were not receiving Plan ahead for your pets Throw your energy into finding anything like adequate care. These What about your own cats? If some- those cats a good, permanent home. situations are tragedies, for the peo- thing were to happen to you, what Use social media, put the word out to ple and the cats involved, and offer would happen to them? Have you your networks, use your connections important lessons about what hap- made provisions for their long-term to shelters and rescue organizations pens when good intentions gallop care? If not, you may be putting your to find the perfect home for the cats. ahead of good sense. own friends and family in the very As in any rehoming situation, hon- If you’re considering a private difficult position of deciding what esty and transparency are essen- shelter or sanctuary, do your home- to do about your animals if you’re tial. Be clear and up-front about the work. Investigate the organization, unexpectedly unable to care for cats’ history, medical needs, and any learn its history, and find out who’s them. known behavior issues. in charge. It’s best to make repeated, There are organizations such as One important note: Beware of leisurely visits to any shelter or “2nd Chance 4 Pets” (visit them at large, privately run “cat sanctuar- sanctuary in which you are consid- www.2ndchance4pets.org) to help ies” that offer to take in virtually any ering placing cats. That’s why work- you get started on this vital plan- and all comers for a fee or donation. ing with local organizations is so ning. Some states also allow for legal These organizations, while they can important. “pet trusts” that let you make legally- sound like an ideal solution, tend to A continuing working relation- binding arrangements for your cats’ be run by well-meaning individu- ship with your chosen shelter or care if you become unable to care for als or small groups who really think sanctuary is your best guarantee them. For more information, consult they can care for as many cats as that the cats you place there will an attorney well-versed in animal they can take in. enjoy long, safe, happy, healthy lives. law. — Catnip staff

1609_CN_Sept2016.indd 13 7/27/16 3:33 PM 14 dear doctor Little is known about whether or not certain supplements actually benefit our cats September 2016

Cosequin and its effects highly on its precise source, the catnip In the July 2016 of Catnip, there manufacturing process AND how it | was an article on the value of is stored and shipped. Check any pet Q joint supplements, highlighting store or catalog and you will find a the fact that there has not been any wide array of products that purport research focusing on the value of glu- to improve pain and mobility. cosamine and chondroitin in cats. The reality is: Unless the product While I have not seen any research has been demonstrated to improve papers either, I have had positive per- signs of disease compared with a sonal experience with these supple- placebo in a well-designed study, we ments with multiple cats. must be cautious about concluding www.tuftscatnip.com One of my cats, a large and that the product does what it says it

healthy male, suddenly lost inter- © A na S ousa | D reamstime.com will do. est in food and was acting as if he Well-designed studies are essential to Also, products that undergo FDA help us understand what works. was in pain. X-rays at my vet’s office approval must be screened before showed arthritis of the spine. We put Firstly, we are more inclined approval and then monitored con- him on ‘Cosequin for Cats,’ a glucos- to use a neutraceutical product tinuously for potential adverse amine and chondroitin supplement because of the impression that it effects. It is common to find that in measured caplets. I gave him two may be associated with fewer seri- some supplement manufacturers a day for the first 30 days. After the ous adverse effects than a drug. And do not collect data and so have not first dose, he started eating again. when a cat’s mobility and personal- reported adverse effects of their After about a week, he was jump- ity improve specifically related to product — for example, gastrointes- ing up on the bed again and acting administration of any substance or tinal upset in some pets from glucos- normally. I cut back to one caplet a procedure, it is quite reasonable to amine containing products. This is day after the first month, then cut attribute the response to the sub- something that pet owners discover back to once a week after that — stance or procedure itself. by chance and which resolves on and finally cut back to only giving Scientists have conducted scores discontinuation of the product, but him one when he seemed to be stiff of clinical experiments in both may make its way only slowly into or sore. As my other cats aged and humans and animals investigating the medical literature. starting showing signs of joint prob- the pain and mobility improving Well-designed studies that help lems, I would give them Cosequin effects of glucosamine and chon- us understand what works and daily for a week or two, then cut back droitin containing supplements. whether it causes harm are essen- to only as needed. When the joint Glucosamine has been shown to tial. We also would prefer not to issues became chronic, I would keep alter inflammation in both in vitro spend money on non-effective strat- them on a twice-per-week dosage. It and in “whole patient” studies, and egies. Large scale clinical trials are appeared to be effective with all four this may be why some patients the best way to get effective and cats I have given it to so far. seem to find relief from this par - safe products into our cats. So if you I hope you find this information ticular neutraceutical. In fact, in ever have the opportunity to par- useful, and can share it with other humans, a European prescription ticipate with your cat in a clinical Catnip readers. glucosamine formulation has been trial of a supplement, or to help fund Phoenix Von Hendy found to be especially effective, research, you will help our aging cat whereas other types do not appear population live comfortably without Dear Phoenix: Thank you for beneficial in studies. arthritis pain. Ayour interesting letter. I have a This finding underscores the fact In the meantime, it remains trial few observations to make about the that — as Dr. Heinze indicates in the and error and anecdote with our subject of analgesic supplements article you mention — the effective- ouchy kitties. What matters most and medications in general. ness of the supplement may depend is that they seem to recover their

1609_CN_Sept2016.indd 14 7/27/16 3:33 PM agility and essential “catness.” studied, there is widespread agree- many diseases and also veterinary 15 If they do this and have no side ment among veterinary researchers therapies have the potential to be effects, then there is little reason not that studies to prove the effective- impacted by the ways a pet caregiv- to continue giving the supplement. ness of a variety of medications or ers’ behavior may change. We our- But back to the placebo effect treatments in animals must be con- selves may strongly influence the in animals — and whether there ducted carefully and a successful outcome when we treat our pets

is such a thing or not. The placebo treatment should prove better than because of poorly understood mech- September 2016 effect is an important feature of how animals in the placebo group anisms related to our interactions scientific studies, and a study is fare. with them. This is an area of health just not well regarded unless the It is thought that the caregiv- care that deserves active research. catnip product or procedure is compared er’s estimation of the degree of Alicia■M.■Karas,■DVM,■MS,■DACVAA | with placebo treatment. “A placebo improvement is in fact due to our Anesthesiologist, pain management effect is any medical intervention own expectations of the result of Cummings School of that has a favorable, non-specific, giving a medication, and so we Veterinary Medicine psychological or psycho-physiolog- over-interpret the result. But also, at Tufts University ical therapeutic effect, but without specific activity for the condition being treated” to quote one veteri- nary research group. (Jaeger et al, 2005). WE CARE ABOUT www.tuftscatnip.com In pain studies in humans, the percentage of people who report improvement in pain while taking YOUR PETS SO the placebo pill or treatment is on average 30 percent (Price et al, 2008). One possible reason for improve- MUCH BECAUSE ment is that humans “expect” to get better and complex mental and physiologic explanations have been YOU DO proposed. But your cat has no idea that the pill you are giving might or Barley, patient should make him better, you say. He Leading the way in and survivor, 2012 has no such expectation. research, education However, veterinarians and pet and skilled patient care, owners alike must face this fact — in study after study of pain medica- with your support, the tions, the improvement in comfort Cummings School of or mobility reported by the Veterinary Medicine at owner ranges from 30 percent to 57 Tu s University is percent and that estimated by the helping to keep your veterinarian assessing the patient own pets strong. ranges from 40 to 45 percent in the placebo group! We actually report an improve- ment in pain due to placebo that is greater than what humans report for themselves. In some cases, objec- Become a contributor to the tive evidence (pain, weight-bear- Cummings Veterinary Fund today at vet.tufts.edu/givenow8, ing and overall condition scores) (508) 839-7905, or send a check demonstrates that the patient has payable to Trustees of Tufts, NOT improved with the placebo Cummings School of Veterinary treatment. This apparent improve- Medicine, 200 Westboro Road, Cummings Veterinary Fund ment on placebo is known as the North Grafton, MA, 01536. Annual Gifts. Daily Impact. “caregiver effect” — and while it is a phenomenon that is not yet well

1609_CN_Sept2016.indd 15 7/27/16 3:33 PM 16 short takes The Aging Process in Cats September 2016 Our pets are living longer and healthier lives, but there is a lack of research on what constitutes healthy aging. catnip

| ikely, this will come as no

surprise to readers, but Laccording to recent research, cats are living longer and health- ier lives than they were fifty years ago. In a study published in the Journal of Feline Medicine and Surgery, researchers studied aging cats and concluded that improve- www.tuftscatnip.com ments in healthcare and nutri- tion have helped to extend the life expectancy of the cat. Today, it’s common for cats to live into their late teens and even early twenties, and researchers estimate that more than 20 per- cent of owned cats living in the United States were 11 years old or older in 2011. It is estimated that

a 21-year-old cat is the approxi- © L ilun | D reamstime.com mate equivalent of a 100-year-old Our cats are commonly living into their late teens into their early twenties these days, so more research is needed to understand the normal aging process. person. However, the study also uncov- aging in cats is critical from both a While the paper is intended to ered the fact that while our cats clinical and research perspective. be an informative guide for vet- are living longer, experts don’t In this regard, it is imperative to be erinarians, researchers acknowl- have a good handle on what able to distinguish between what edge that there is much more we healthy aging looks like. In an would be considered ‘normal need to learn about aging cats. effort to provide better resources for age’ versus unhealthy aging “Although we provide a thorough for veterinarians, researchers changes,” wrote the researchers. review of the current knowledge, from various institutions com- The 18-page review covers it is clear that there is a great need piled information from existing what is considered to be normal for better understanding in this research to put together informa- aging and physical symptoms area,” wrote the researchers. tion on aging in cats, which was that don’t negatively impact the You can access the study online also published in the Journal of cat’s quality of life — some weight at: jfm.sagepub.com/content Feline Medicine and Surgery. loss, reducing grooming, a slightly /18/7/533.full.pdf+html — Catnip “An appreciation of normal thinned coat, etc. staff

ahead in catnip Subscription questions? Call 800-829-0926, email customer_ Danger: Antibiotic Resistance Domestic Violence and Pets [email protected] Medications designed to ward off It can be challenging enough to feline bacterial disease may become escape an abusive relationship or write to: Catnip, PO Box 8517, ineffective over time. Here’s why without adding a pet to the Big Sandy, TX 75755-8517. — and what you should know. equation. Luckily, there is help.

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