Hi everybody, my name's Sam Taylor and I'm really pleased to be here today and talking to you about Cat Friendly clinic. It's a great passion of mine as a feline medic and as someone who's involved in the development of the scheme, 10 years ago, actually slightly longer than that ago, but it's the, the official 10 year anniversary. So the aim of my talk today is to really help you understand why, well sort of why cats are in our homes and our clinics.

And you probably think, well, what's that got to do with it? I thought you were gonna tell me about waiting room design and things like this, but it is actually really important. In fact, key to understanding the behaviour of cats in your clinic, and that will then help you understand how to modify the environment and your handling to make yours and the cat's lives much easier.

And so it's important to understand emotions and how cats learn, which sounds a bit behaviory, but I've learned a tonne about this recently, and it all starts to to click and fit into place. We'll talk about some of the evidence of the benefits of being a cat friendly clinic to all stakeholders, so the cat obviously, the owner, you guys, and the, the clinic and the bosses as well. And then, you know, a little bit of time looking at equipment and and the clinic design as well as handling.

So that I can convince you and teach you how to think cat. So where do cats come from? We often think about them associated with ancient Egypt and, you know, the hieroglyphics and things, but actually they were probably associated with humans a little earlier than this.

And the way that they came into our lives is quite different from that of dogs. But let's look at this little wildcat, we've got a picture on it here. So African wildcats are the ancestors of our modern cats, and I think you'll agree they don't look hugely different to the modern cats that we see today.

And actually they have characteristics that are exactly the same as our modern cats, so they're excellent predators, but importantly, this is important, they are prey to larger carnivores. So that means that, you know, so the, the . Coyotes or the you know, the sort of dog type predators, as well as leopards and bigger cats would be quite happy to kill and eat these little guys.

So they're very, very hypervigilant of their environment, but they are independent, they live alone, so that's important. So the history of cats is very solitary. That's probably why we get lots of problems in multi-cat homes, although they're adaptable and they are able to to cope with that in modern times.

The highly, highly territorial, which is something else that continues with our modern cats. So I want you to think of cats as tamed but not domesticated. So what's happened is that natural selection over time meant that more tolerant and bolder individuals learnt to live alongside humans as they saw the benefit of humans having farming and humans having grain stores.

But that domestication has been restricted until really relatively recently by their dietary requirements. So cats couldn't be completely fed by humans until we worked out the connection with requirements for certain proteins like taurine. And the drive to hunt has never been selected against because if you think about where most people get cats from, it's not from breeders, although obviously there is a, a large proportion of cats that are are from breeders and purebred cats.

But if you think about the history of cats, they actually were selected to hunt, so the hunting was a prize skill, wildness was a prize skill. We've never selected against that. And so they retain this hypervigilant nature and they retain this drive to hunt.

I want to convince you that there is a little wildcat in your home and in your clinic, and so we need to consider that their responses and their behaviours are perfectly normal and natural for what they are. We are trying to make them be something else, and that fits some cats, but it doesn't fit every cat. They're quite diverse in their, genetics, their behaviour, their background, and the way they behave is a response to all of that.

But yet they have adapted to be pets and they can live happily with other species, and don't get me wrong, when you look into this, you almost think cats shouldn't be kept as pets, but they can make excellent pets in the right circumstances. And we know that cats live, you know, lovely lives with humans and they can be very, very close and very bonded to us and all of us, probably many of you listening have cats and know how important they can be for for our owners. I just want to also put in your mind about their senses and how this affects their clinic experience, because this is really important to cat friendly clinic.

No, I don't expect you to read all of this, you'll find it coming out later this year in our cat friendly clinic updated guidelines towards the end of 2022. But really the point being that they have excellent senses of vision, hearing, smell, particularly, we often think of dogs as being great at smelling, but actually cats have got, the ability to smell is about 1000 times more sensitive than humans. And that means that your clinic disinfectants are going to be very offensive to them.

It means that they can detect dogs, it means they can detect other cats very, very easily. They, her vision is not as good as ours close up, but is excellent further away, and this means that they are constantly looking around. In fact, their eyes are, are, they poke out basically more than ours.

They have a, a, a wider, range of vision because of this looking for prey, but also potentially becoming prey. And they have a brilliant hearing which is superior to ours and actually superior to dogs. And so that means that you're ringing telephones, you're barking dogs, your loud music, you're loud talking, all is absolutely filling their senses, and you can see how that would reduce their tolerance to handling.

I mentioned the difference between cats and dogs and how cats are definitely not small dogs, but I just want to talk about what this in slightly more detail cos it just helps you put perspective in it when you handle the different species, you know, differently and understand them differently. So wolves always had an advantage. Their brain was developed for social living.

Their communication is much better as far as visual communication, so they're very good at showing each other facial expressions, so if you think about . You know, growling and snarling and all of these type of things, they have really good coms between each other. Cats have never had to do that cos they've never lived with each other, so they'd had no requirement for that.

That's why they're very good at communicating through scent, for example. And dogs have got a longer history with humans and they've really been inbred and lived bonded to us. So they have an attachment to other, other dogs and they have an attachment to humans, and if you think about it, they're very, very familiar with leaving their home and leaving their territory.

That's routine. It isn't for our cats. So dogs are truly domesticated, their matings are usually planned, and they have been selected for their appearance, and sometimes their character, and actually we've made them into, you know, various things which you could argue also happens in, in cats, but much less often in the cats that you're seeing in your clinic, you're not going to see as many Persians as you do domestic short hairs or as you do pugs and and French bulldogs.

So we have this real variety that we've made and we have dogs that have been bred for obedience and jobs, just really, really different how they're in our lives to to cats, and yet we sort of expect to to be able to treat them the same sometimes. And I always say when I show this slide, there's not there's a reason why there aren't mountain rescue cats because obviously most of us who have cats would know that they they can't be bothered. They've got something better to do.

So, let's think about emotions, and, and this is the, the sort of slightly behaviory bit, and I don't claim to be a behaviourist, but I've tried my best to learn from, Sarah Heath and my other colleagues and Sarah Ellis, who I work with at ISFM. And they've taught me a lot about this, and I was a bit like, you know, this is kind of pure behaviour, I'm a clinician, but actually it's really, really helped me understand their reactions. And so those emotions can be in the clinic we're talking about here, but this would also potentially happen at home.

You have a group of negative emotions, which includes fear and anxiety and pain, you're probably thinking about pain is not an emotion, but it's actually really interlinked with these other negative emotions. They will heighten each other, for example. And we know about this link in humans between, you know, pain and chronic pain syndromes and, and stress and anxiety.

Frustration we often don't think about. So frustrated cats can be quite difficult to deal with. I had a cat just this week, a British Shorthair.

He was not fearful, he was not anxious, but he wanted to do what he wanted to do. And that was not have me hold him for a blood sample. And so those cats can actually scratch and bite trying to escape and cause human injury.

But their emotion is quite different from that cat that is fearful and anxious and and trying to, you know, thinks you're trying to kill them. The fearful, anx anxious and painful cat will also react in a certain group of ways. So their behaviour will show either inhibition, so that's that cat that freezes on the table.

Now those cats you can get lots done, you can do your job, but actually they are suffering. And we are, by not interpreting that and acting on that, we're actually neglecting their their emotional health, which we have a responsibility for. So those cats that are very inhibited are not dangerous to staff, but they are still suffering.

And then we have avoidance as a reaction, so this is what cats would prefer to do is leg it. They'd prefer to run away. When they are restrained or they are held, you know, they're held for a blood sample or they're in a cat basket, they can't do that.

And that means that they may have to resort to repulsion, which means aggressive behaviour to get you and me to, you know, leave them the heck alone. And that's their last resort. So I, I'll tell you a little bit about my my dislike of terms like naughty and spicy and.

And things like this, these cats are reacting based on their negative emotions. And then what we want to encourage in the clinic is positive emotions, and they call this the desire seeking emotions. So that's basically feeling good and looking for stuff that makes you feel good.

It's my very basic behaviour. So this is seeking things like food, positive contact with humans, warmth, I know it sounds really basic, all of these things and promote positive emotions. So a cat that's cold is not gonna feel as inclined to have positive emotions as a cat that's kept warm.

It sounds silly, doesn't it, but these things are really important. So now I've told you about their background, I've told you about their senses, I've told you about their emotions. Let's think about that cat that's coming into the clinic.

And those senses are completely overwhelmed by unfamiliar situations, the car journey, the cat basket, firm handling, barking dogs, strange smells. They have no ability to escape. It's a perfect storm for for a cat that's going to behave, in response to those negative emotions at the clinic.

So we've got to empathise with that. And what happens really is this, this cycle of stress and fear and then resulting in what we call protective behaviour, which I know that you and I would be more familiar with terming aggressive behaviour, but we're trying to just change the narrative a bit on that because they're trying to protect themselves, they're not trying to kill you. It, it might feel that they're trying to kill you, but they're trying to kill you so that you don't kill them.

So this protective behaviour is what we're talking about. And so you can see what happens, we have all of these these stressors and we call it kind of stacking up these stress stackers. They're unable to withdraw and escape this because they become very fearful, and then they become, you know, if we don't read that behaviour and respond to it, then we end up with a cat that is aggressive.

So my question to you is, what do you see in this image? A vicious cat, an angry cat, a naughty cat, I hear that quite a lot. A dangerous cat?

Yeah, I agree, this is a dangerous cat. And we know that staff injury from cats is a big issue. We know this from the discussion with the corporates and we know it from some research that there are days off sick because of injury from cats.

Now, I'm coming at it from the cat's emotional point of view, that if they're injuring people, they are very, very unhappy and we are doing them a disservice to their emotional health. But actually it has practical implications in the clinic because this is a dangerous cat. But what I see is a frightened cat.

So, you know, and people will say this to me, they say oh I wasn't frightened, he was just nasty, he's just really nasty, spicy, spicy cat, naughty taughty, all of these things. But no, really, really do object to that. These cats are basing their behaviour on, learning.

So they've learned through multiple clinic visits sometimes. You know those ones that are OK the first time, they're worse the next time, they're unhandable the third time. They are basing their response to their learning.

And so probably the first time they were more inhibited, it didn't help them. And so they learnt to show protective behaviour earlier and earlier in their interaction with you, and then you end up with a cat, you can't get out of the basket. So this, you know, is a really important point I think that they're not, and, and labelling them is not helpful.

So calling them spicy and naughty and and evil and things like this is just not helpful. They're, you know, they are just responding, they've been pushed to respond in a certain way. What we want to do is avoid the behaviour developing, but this is real life.

I'm not going to give you a talk about totally unrealistic expectations here, this is real life. We would like to avoid the behaviour developing, but if the behaviour is already present, what we need to do is not make it worse. And that means using sedation, using pharma pharmacological methods to help us get the job done with not making it worse, basically.

And gabapentin, you'll hear me talk about in this talk, we're very big fan of using gabapentin. It's very safe. So we have recent research showing it being used in hyperthyroids in cats with chronic kidney disease.

It's a safe drug, even if you don't know the clear health status of the patient because you can't get the bloods because they're not, you know, you can't handle them to get blood samples. You can still prescribe this to clients. The liquid, it doesn't taste brilliant.

So I'd usually tell people to fast the cats overnight so that they're hungry and then give them the gabapentin either as a tablet form in a pill assist or with liquid. Now, you're thinking, well, I've got a cat on my table that I can't handle. But actually, we know from research that owners find it very distressing when their cats behave in these ways.

It upsets owners. So, yes, some owners won't care, they just want to get the job done. But a lot of owners will be receptive to you saying, your cat is clearly very unhappy, and I hear this from people all the time and they'll say, oh, my vet told me that they were naughty and unhandable.

And I've said, but I think your cat's scared. And they've said, Oh yes, thank you, I, you know, I agree that they're scared, they're not like this at home. So those owners are gonna engage with you and you can say, well, look, next time we don't want it to be like this, so we're gonna try these things.

Or injectable sedation is the other solution, we'll talk about that a little bit later in the talk. But it's, it's, I, I certainly reach for sedation much, much earlier than I used to. There are safe combinations that can avoid us making all of these behaviours much worse.

So we've talked about this cycle of stress, fear and aggression of protective behaviour, and this slide really was to, to just say when to consider chemical restraint, and that's when you have got these severe signs of anxiety or inhibition itself because we, as I mentioned to you, the inhibited cat is also very unhappy. If you think that the procedure's gonna take longer without chemical restraint and in situations where you're anticipating something painful, OK, so imaging, all sorts of things, it might even be microchipping or something like this. We've got to think ahead a little bit.

Now stress cats, we don't want stress cats because of what we discussed as far as their, their reaction to it. But it's also gonna affect your physical exam, so you're going to be impossible for you to interpret these type of clinical findings. So particularly if you're dealing with a potential diabetic or hypertension, so white coat hypertension, you know, is very difficult because we don't know if that cat is truly hypertensive.

And I've seen cats whose blood pressure will be almost towards 200 from fear and stress alone. So I used to work in a clinic, er PDSA clinic that didn't have a separate cat waiting room and the cats would wait next to the barking staffies with their heads in the front of their cages, and those cats had hypertension, white coat hypertension for absolutely sure. It will change, you know, other things, so your blood results, but also we know from research that actually stressed cats take a longer time to anaesthetize, their sedation is less effective.

But we learn more and more in humans that chronic stress, but even actually stress around the perioperative period, can delay wound healing and promote the development of chronic pain. So if you or I are stressed before our anaesthesia for our surgery, we may be more likely to develop chronic pain afterwards. These things we don't know and cats are very hard to study, but it's, it's to me, I think there are wide reaching effects here that we can consider.

And we've mentioned that stressed cats cause injuries, and this is something that even for people who don't particularly care about the cats welfare, perhaps, which is fine, you know, some people will say they're not cat people and they're, that's not their interest. However, their interest may be to reduce staff injury. And we actually did some, some research on this, so we looked at cat friendly clinics versus non-cat friendly clinics.

We found that there was a significant difference in staff injury from cats with less injuries in cat-friendly clinics. And this has an impact also on insurance claims and things like this, it's quite a big in America. And think about this whole cycle and the wide reaching kind of effects of a bad experience in the veterinary clinic.

So if we have owners who are reluctant to visit a vet with their cats, they may have a lack of knowledge of their cat's health. But if they visit a clinic then that is stressful to the cat and the owner, and they. Don't feel that they're looked after with good knowledge.

And they have perhaps they're prescribed are here all the time, prescribed tablets that they find with no guidance that they find impossible to give. You end up with this vicious cycle of bad experience. This doesn't help the clinic.

You'll have less income for a start, because these people won't come back. Whereas if we have a cat friendly clinic where we educate our owners, we help them give medications, we handle our cats sympathetically and kindly, we have a more engaged owner and we potentially have more clinic visits. There's even more evidence from from that.

We know from some really nice work by Carlie Moody, who produced a couple of papers on this, that actually full body restraints are holding cats in heavy restraint means they are more likely to struggle, and they're more likely to have obviously signs of, of stress, and when you let them go, they're more likely to run away. Whereas if you passively restrain them, so with minimal restraint, then they're less likely to wriggle and they're less likely to run away. And we know again from another paper by the same author that clip restraint, and full body restraint and scroffing is very negative, it's highly negative for cats compared to passive restraint.

So we now have evidence of what we knew already. But also a few, a bit of research which isn't published research, but it's, it's research that's been done within some corporate groups, is looking at improvements in clinic income, and client retention and newA registrations. So we know, the owners can be more fussy now about where they take their cats, and we're trying to improve the marketing of cat friendly clinics, so maybe they're gonna start looking for them.

In general, then, this makes the boss happier. And there's an article from Spain here looking at cat-friendly clinics showing that they generated a higher percentage of their revenue from their feline patients, had more visits, and each visit had a higher transactional value. So, and cats, feline owners visiting cat-friendly clinics spend more money, and they do things like buy the pet food there.

So it's of benefit to, to everyone, you can convince the boss. Now I've been talking about cat friendly clinic and then I realised that, you know, not everyone may be completely aware of the scheme. But it's, it's a scheme within everywhere apart from North and South America, basically, where they have the cat friendly practise scheme.

But we have the cat friendly clinic scheme, just a, a name difference, and, and it's organised by ISFM in Europe and the UK, and Australia, for example, and the Asian countries too. We have gold, silver and bronze as an accreditation. And it basically looks at clinic layout and design, but you can adapt the the scheme to whatever layout you have.

And we talked about profits, client bonding, and owners seem to be able to really tell the difference. You don't have to build a new clinic. OK, so now you know why, I'm gonna try and tell you how, and this is probably the bit that you're, you're keener to see.

So what I want to really stress the importance of is involving the whole team, and that's really, really important. So if we have just the cat advocates who are very, you know, very invested in the scheme. It can easily be sabotaged by other members of the clinic.

So it's something that's really important to spread the word, have on new staff inductions, you know, this type of thing. It is a philosophy for the clinic, it's not optional. And I start to be quite sort of pushy with this in our clinic.

This is not, it's not optional, we are a cat friendly clinic, and it's as important as learning how to. Disinfect an area or how to wear, you know, what uniform to wear, it's part of the the clinic protocol. And so we'll talk about clinic areas and equipment handling, and then obviously feedback and learning, we can all improve.

So if you're listening to this and you are a cat friendly clinic, we are a cat friendly clinic where I work, and we definitely have areas of improvement. And reminders, things sort of drop off that you can improve. So really the cat friendly clinic starts before the cat comes into the clinic, and this is why it's very important to involve receptionists as well in in the part of the cat friendly clinic team.

And that's because they can give advice on how to travel with the cat and important things like habituation to the cat basket. So here's an image of a cat, cat basket within the home that's been made really, really cosy, it's part of the environment, has doesn't smell novel, and that cat's gonna feel much safer in that basket than one that's been, has dust and cobwebs on it that's in the garage. And so in your registration process, you can include information about how the cat responds.

And if the cat is, you know, the owner reports that the cat's incredibly fearful or difficult to handle in the veterinary clinic, then things like gabapentin can be prescribed. Now you may say, well, how can you do that before you've seen the cat? But I think that we could get into a discussion about your sort of teleconsults and and this type of thing, and obviously we've got to be quite careful with patients that you haven't seen previously, but it's something that can be discussed.

And then just some clients are really anxious about the visit and you can talk to them and say, well look, we're a cat friendly clinic, so we're gonna try and make things better for your cat. And silly things like having the right baskets, so people that have these ridiculous baskets that you can't get the cats out of. But they probably don't know any different.

So if we educate them about the right basket that we can take the top off, your life is instantly easier in the clinic, in the consults. Now the waiting room, people often talk about the waiting room and say, well, look, we don't have room to have a separate cat waiting room, and lots of people don't. But there are ways that you can provide barriers and blockers to separate cats from dogs.

And that's really, really important, as well as things like making sure there are areas where the cats can be lifted off the floor. And Importantly, and very simply, having blankets or towels available to cover the baskets. Just that will help improve the cat's, experience of the of the clinic.

So they're not seeing dogs, and they are higher up in a vantage point and they have somewhere to hide potentially within the basket by it being covered. OK. Now the other thing is, think about where the cats are put while people are paying.

I, I'm, I can't, I don't have time in this talk to go through everything, so please do go on the catfriendly clinic website for more info. But think about where clients put their cats when they're paying, because on the floor in front of the reception being sniffed by dogs is not helpful, even if you've done all the cat friendly clinic stuff before, and during the appointment. So a few examples here, you can have a separate cat waiting area and obviously that's optimal, but as we said, you can't, not everyone can do this, but here's a couple of examples of where side rooms have been converted into cat waiting areas.

And just remember that your receptionist can be the guardian of your cat friendly clinic scheme and reminding owners that they shouldn't be putting cats on the floor and they shouldn't be in the dog waiting areas, cos people still do that. And as I mentioned, covering cats with covering the cat baskets. So some cats do need to do like to have some visual contacts, they can be frustrated if they're completely covered.

So I usually cover but leave the front open so they have that option. As I mentioned, if you can't separate cats from dogs in the waiting room, then you can do a temporary barry, you can make it look pretty, you can put some, posters and things on it there. Now I should actually remove this because the cat's on the floor, but I use it as an example to remind myself that it's all.

All aspects of it are important, so in this clinic we've got a really nice division here, we've got an opaque area between a horribly fat pug and this cat, but the cat is in an uncovered basket and you can imagine it would feel very vulnerable there, and it's on the floor at the level with the dogs and with no vantage point. So it's important that we get both bits right and our clinic is guilty of this, so we have a separate cat waiting room, which is really nice, really smart. But then sometimes the cat in an uncovered basket will be walked past dogs, you know, directly almost in contact with them in order to get through to the consult rooms.

So it's, it's a bit difficult, isn't it? The other alternative is to have certain consulting times that are cat only, first thing in the morning or something like this, or at lunchtime when the clinic's quieter. Or COVID actually helped with this, so having clients wait in the car, simply not exposing them to all the dogs and the noise of the waiting room.

Now consult rooms, again, it's ideal if they're cat only, but I know some of you are gonna say, well look, we just can't do that. That's fine, but it, you know, let's think what we can do to really optimise this. So we have the same problem with ophthalmology and dermatology, and that they don't have their own cat consult rooms.

So let's make sure that the cats are seen before the stinky dogs. And so we try and book. Appointments first, or we make sure that we clean very carefully between patients and that includes sweeping up manky dog hair and if you've done anal glands emptying the bins, because imagine you've got a little cat coming into that environment it's gonna think, jeez, I'm, I'm gonna die here.

This smells of entirely of predators. And so when you go to take that cat out of the basket, it thinks it's gonna die and so therefore it's going to respond with a behaviour to that, you know, in response to that. So you can try and minimise the effect on your patients.

You should always have a non-slip table with a towel on it, ideally that that's been sprayed with some alleyway. Don't keep going in and out of the room, make sure you've got everything. These scales for cats are cheap now, there's no excuse not to have these.

They used to be quite expensive, but they're not anymore. So they need to have a scale in the room so we're not going in and out. Do not put that cat basket on the dog's scale in front of the dogs, and.

You know, make sure that you've got your stethoscope and everything that you need in that room, the vaccinations and a little, we have a little lab caddy so that we've got all the lab equipment, so you're not going in and out, opening the door, changing the smells, making noise, etc. And we could spend a long time talking about consulting in the consulting room, but the principle being that ideally we're examining cats, either in the base of their basket, or you can have an alternative high sided box for them to go in if they've got one of these. Ridiculous baskets, you know, that you you have to open the front of.

So here's my colleague, Natalie at the feline ageing clinic. Natalie's the head of ISFM, but she also works with ageing cats and she's examining her cats, you know, under a blanket, in the base of the basket, so giving them choice about where they want to sit and where they feel comfortable, not dragging them out of the basket to examine them. And we often find that we have dog treats in the clinic, but do you always have cat treats?

Remember that desire seeking positive emotions. Here's a kitten. I want this, I want to be able to handle this kitten when he's 10, and you guys want to, you know, have a lifelong experience with these patients, and therefore you will need to promote the positives.

If you don't have licky licks and cat treats when you're doing cat vaccinations, you've really missed an opportunity to teach that cat that the clinic is quite, it has, has a positive effect on them. So think about that. Cheap licky licks anyway.

Examine the cats where they choose to be examined. So again, it's about giving them choice. So lots of cats I find they like to sit on the scales, I think because it has a slightly, a lip on it and they feel slightly safer.

So that's fine, I'll examine them on the scales. Lots of clinics and really nice cat concert rooms will have perching places, but just make sure that they're not too high, that you can't get the cat off. So ours has got a very high shelf, and the cats love to go on there and they're very relaxed, but then I can't get them off.

So just think about your, your consult room design. If they're happier on the floor, let's examine them on the floor. And here's a cat, quite happy sitting next to his owner on a cushion, and I can examine him there.

Why does he have to be on the consult table? Let's move on to hospitalisation in the interest of, of, you know, having enough time to discuss everything because I think this is a really important, you know, really crucial area of, of feline medicine as well. Because again, we, we are talking wide reaching effects, so I'm telling you how to reduce stress in cats.

This is gonna reduce their hospitalisation times, this is gonna reduce their need for medications, their need for feeding tubes because their appetites are optimised. It has really big consequences. It's not just us being sort of fluffy neurotic cat people.

As it used to always be thought that we were a little bit intense and they used to call us that used to call us the fluffy cat people. But the fluffy cat people know that the cats recover quicker if they're not stressed. So think about your cat ward and ideally you're gonna have a bank of cages that, like this, without cats having any visual contact with each other.

So one of the problems, one of the things we sometimes see are cages in perpendicular to each other, and that's a nightmare. And if you have that in your clinic, I would suggest that you try not to use the cages on the other side. And if you have to, then the, the doors must be covered.

They must be covered with blankets or towels. And we also see some very other innovative ways that people do this, and they cover with blinds, so you can put blinds over on the top here so that you can cover that. Or movable, sort of barriers on wheels so that you can cover that.

That's also particularly important if you have an examination table within your cat ward. What you don't want is cats seeing other cats being examined because those cats are gonna exhibit pheromones and visual cues of stress, and that's gonna be picked up by the other cats. And the cat on the table is going to be very stressed by being watched by other cats, it's hugely intimidating and threatening.

So, cover the cages basically, if that's your only option. Ideally, we prefer the cat to be taken to a consult room to have a procedure done, for example, so they're not in visual, you know, they're not in view of the other cats. But we've got to make do with what we have.

So use those kind of cheap solutions as blockers. And my criticism of these cages would be that they need to be covered. So we would have a blanket on everyone, and that blanket can be sprayed with pheromones and it can go round the clinic with the cat so it has some familiar scent.

So think about those kind of things of sight. If you're designing one, if you have the luxury of designing award, then you can think about the amount of space each cat has and providing areas to hide and perch within the cage, which is fantastic. But that's not gonna be an option for every clinic.

And then we need to think about our food and our food bowls and our litter and how, how we provide all these resources. So just want to show you a few tips. One thing, and I'm, I'll show you a bit of research in a moment that's really important and absolutely not and it's obligatory and I get very moody in the clinic about it, is that cats must have somewhere to hide in the cage.

It's not acceptable for a hospitalised cat to have a just a vet bed. And I, yeah, I do get moody about this. And this is because we know that stress is instantly reduced if they have the ability to hide.

And it does not have to be something expensive. Cardboard boxes are absolutely fine, they love them, we know cats like cardboard boxes. Ideally, they also have the option to perch and so these beds don't provide that, but the the cats protection castles do.

But equally, their cat baskets covered in a blanket provides an option to perch and to hide. And then this is what I was talking about of covering the cages with blankets. Recording information is also really important, so you can see here that one of my colleagues, my lovely nurses, has written, you know how to handle this cat.

So they're like chin rubs and gentle voice, don't give me a castle cos I panic when it's lifted. And that's a problem with these castles, and it's one of my criticisms of them is that it's very difficult to get fearful cats out from underneath them, you have to take the whole castle out, and that makes that into a bit of a trauma. Whereas when you use these type of basket solutions, you can take the cat round the clinic in, you know, in the basket, so that can be much better.

And we're working on some more solutions for this. So think about what you've got, but if you're me, I get moody about it and I just go and get one of the boxes that the drip, that the fluids come in, and put it on the side and you've instantly made that cap feel better. There's not many things where a cardboard box makes it feel better.

This is one of them. And there's evidence behind this, so when you, anyone argues with you, you can say, no, hold on, there's a lot of research showing that cats that have somewhere to hide are less stressed than cats that don't. And as your cats that have hide and perch options, so in the USA they tend to use some of these cardboard hide and perch options.

These type of things reduce stress even further. So we know that giving them a bed is best if they have somewhere to perch as well, then that's, you know, absolutely optimal. So there is scientific evidence behind this, it's not just us being fluffy.

A few other bits and pieces is thinking about the layout of your cage, so making sure ideally that food and water are away from each other and away from the litter. Now that's difficult in a small cage, but you have to do the best that you can with that in separating the resources. And then just a few things, practicalities.

I know bug bear in mind is doing TPRs twice a day. There's a rare cat that needs its temperature taken twice a day, truly, truly, truly, truly, an FIP case that you're monitoring the pyrexia, but even then we can go on their clinical presentation. So think about whether checks are needed, leave them alone, as much as possible.

If you do need to do something then time it all together so you haven't got, You know, an injection of pain relief and then an hour later, a pulse check, you know, this, this makes no sense, combine it to minimise handling, . Time things for after analgesia where they probably feel more calm, so if they do buprenorphine at 10, then you know, do their TPR at 10:30. Just think about those type of things that are easily missed in a busy clinic when everyone's, you know, chasing the tail trying to catch up with everything.

And remember that inhapetence and lack of urine and faeces, which is something you're gonna see commonly in your hospitalised patients, that's a sign of stress in itself. And we are just producing some guidelines that will come out in, July 2022 on management of inabpetence in hospitalised cats because stress management is a really important part of encouraging voluntary intake. OK, I could spend a long time talking to you about hospitalisation, but I'll try and move on a little bit to to interaction.

And, and that's really again this philosophy that should pervade your clinic, which is that cats are handled with care, gentleness and respect at all times. And that means that if they are trying to kill you, as people always say, which they're not trying to kill you, they're trusts trying to not be killed, they still need to be handled with respect, and we still need to say stop, this is not working. We need to bring in some sedation, we need to reschedule if possible.

We need to think about what we're doing here. And it really just is a, a way of looking at this, this creature's behaviour. I know it sounds silly and probably you guys are already doing all of this, but there may be someone in your clinic that doesn't quite get it.

But it's a philosophy. Cat consultation times, it's really hard with 10 minute consults to do this stuff, and I'm sure you're thinking that while I'm talking. I've got to get the cat out of the basket cos I've only got 10 minutes, so I need to be examining it whilst the owner is talking.

It's gonna make your life much harder, but things like taking the tops off baskets and teaching your clients to bring cats in those type of baskets, you know, will make your life easier. But you know, some discussion about whether you can do a good job with cats in 10 minutes. I'll leave that to you to discuss with with the bosses, but remember that clients of cat friendly clinics spend more.

So having a longer consult and improving your care of cats may mean that they come back more frequently and therefore buy more preventative healthcare, etc. Etc. And no cats should be scruffed ever.

And if you're listening to this thinking, oh, there's certain situations where they need to be scruffed. No, there, there aren't, sorry, there aren't. I've been a feline specialist for, well, I've been a vet for 20 years and I've been a feline specialist for 10 years, 11 years, .

I know that first opinion is different from referral. I spent my time in first opinion. And sometimes it feels like you get the job done better by scruffing them.

But it really doesn't cos next time you see it, that's cat's gonna be unhandable. And so there's no need for it. We have better sedation, we have better handling, we have towels, we have ways of doing these things.

OK, and we're really neglecting part of our job by doing that. This quiet and slow and gentle handling gets the job actually done quicker than roughly grabbing cats and then getting into a battle with them where you can't achieve what you want and now you've got to sedate it. And so think about this kind of respectful handling, doing things in the basket, so I try and take bloods in the basket here, I've not moved the cat, minimal handling, so we're not holding the legs, we're just lifting the chin.

Probably should have a blanket on this table. Taking blood pressure within the bottom of the basket, making sure we have headphones so they can't hear it. Again, we're covering the the table with a with a soft bed.

So here's a few other images really, again, of just using a towel very gently, using our bodies to keep the cat feeling secure, examining cats under a blanket within their basket. And you can sedate cats like this, so if you have cats that are challenging, you put your blanket, you take the top off, you put your blanket over, you inject them, and that's then you can leave them alone in the dark and proceed later. So if the cat does react badly and gets stressed, read their body language, stop, move away, let them relax, and then try again.

Things like ELA are very, very useful, make sure that you leave it enough time, and what we do is we cut off the finger of a glove, put it over the blob of Emler, and then put some fat wrap over the top because by putting an inclusive dressing on, that will work much better. And then think about when you're getting into a battle and things are being, you know, challenging, can it be postponed or done later under a sedation? So can you take the bloods later?

I will often say, look, don't leave it, leave it, we'll take the bloods when they're sedated for ultrasound or whatever else we're doing. So just, just applying these, these kind of logic and less is more. I mentioned sedation, I told you I was gonna come back at it, come back to it.

Things like butterphnil can be very useful, sometimes they're not enough if a cat has become, you know, really upset, then butauphnil might not cut it. But for some cats that can be enough to take the edge off them. I mentioned if you're planning other procedures and combine everything together.

There's a reluctance sometimes to sedate if we don't know the clinical status of the cat. So the cat is so challenging that we can't, you know, do a good examination. However, there are actually very few conditions that will preclude sedation, to allow you to do an examination.

If you're using the appropriate dose and monitoring and you've you know, obtained the appropriate consent. And remember you can give gabapentin in the clinic, so if you have a cat that's extremely challenging that you need to take a blood sample from, and the client's there and they're gonna get peeved if you send them home. We had a cat the other day that was completely unhandable.

Had come from Dubai, had obviously some very bad experiences in clinics, been gassed down and things like awful things like this. And that cat, we, it had been fasted, which is helpful, cos it was hungry and so then we gave it some gabapentin in some Liylis on little. You know, a little saucer, and you're probably thinking, well, hold on, you're gonna anaesthetize these cats and now you're feeding them.

But if you look at the most recent guidance of anaesthesia in cats, you can give them a tiny bit of wet food 4 hours before an anaesthesia quite safely, depending on their underlying condition. So review your fasting protocols as well if this is interfering with your use of appropriate anuallytic therapy. So we gave gabapentin in Licky Licks, we left the cat alone for an hour in its basket, we come back later, wasn't happy, but we could then easily put a little towel over and give an iron sedation.

So don't, and also hospitalised patients that are very anxious and challenging, you can use gabapentin in the clinic and some cats will take it in pill assist. So as I mentioned, the dose that we look at in the research tends to be 100 milligrammes as a single dose per cat. 2 hours before the appointment.

If they've got chronic kidney disease or they're frail or they're small, then we'll give them 15 milligrammes. And we've warn owners that for the rest of the day, they might be a little bit wobbly and so block off the stairs, for example. So, and particularly if you have older cats, they'll be a little bit arthritic and things, they, they might be a little wobbly afterwards.

But then also think about combination sedation if you need to go further and chemically restrain these patients. But remember your sedation won't work if you've already, everyone is already very upset. So think about earlier intervention with sedation.

And then keep the cat in a quiet and dark area and you can use safely in the vast majority of cats, even cats with underlying illnesses, you can use low doses of dexamedatomidine with Alfax and butorphennil, for example, and there is some great information about that, you can find particularly in the open access AFP anaesthesia guidelines, for example. So just Google AFP anaesthesia guidelines and you can find some doses and combinations. Just finally approaching the end of the talk, just a little bit about equipment that can be really helpful for you to be cat friendly.

I think the philosophy is more important than the equipment, but the equipment will, will help you. So things like using soft buster collars instead of hard plastic ones, using quiet clippers, using blue needles or. Even orange needles to take samples.

There's copious research that shows that you, you, get adequate results from your bloods without, you don't cause hemolysis by using smaller needles, and I know several feline specialists that will only use orange needles in cats that have done for years, and it's made no difference to their results. And as I say, there is published research on that now. Things like having a portable ultrasound may seem like a a a huge luxury, but actually bringing the ultrasound to the cat, allowing the cat to adopt a natural position.

And in dysate patients, this is totally brilliant. You don't need to take an X-ray of a dysne cat, you can just put the ultrasound on and look for a fusion, for example. But you can see here in our clinic here, Emma's just letting the cat adopt a natural position.

There's no excessive restraint here, while we scan for fluid or bee lines on the chest. Prevent things like preventing hypothermia again is I know you'll do this as routine, but obviously the cats are smaller patients and therefore having things like bear huggers, but even just putting baby socks on their feet and using bubble wrap, it's just having a, a, a respect for their sort of metabolism and their likelihood to become more hypothermic and you'll improve their recovery. So there's lots of different bits of equipment, but as I say, I think it's more how you, how you use things.

So in conclusion really, I want you to think about the background of cats when you see that cat that's behaving in a way that is making your life harder. And remember, there's no such thing as a naughty cat. There's a fearful cat or there's a cat that's learnt to protect itself in the clinic.

And inexpensive adjustments can be made, so a blind, a divider, but more importantly, a handling philosophy, is very inexpensive. You don't have to knock down the clinic and build, you know, a new entrance for cats that, that would be brilliant if you can. It's about that and about attitudes and training.

And you know, do visit catfriendly clinic.org. We've got lots of videos on handling and and this type of thing.

But Siva helped ISFM produce a number of videos about removing cats from baskets and also restraint for blood samples, etc. That you might find very useful, and you can find them on there. So thank you very much for listening.

If you're not a cat friendly clinic, then please consider it and have relaxed cats in your care.