Hello, thank you very much for that introduction, and I hope everything is projecting as it should. I would like to also start by thanking Royal Cannon for inviting me to speak today on a topic which is dear to me, the senior cat, and it's been absolutely lovely hearing all of the other presentations, and, I think some of what I have to say, nicely compliments some of the previous speakers. I put my contact details on this slide, and I will reference my website in a few places.
I would actually love you to visit it. And speaking of surveys, I have got one open at the moment, which I'm particularly looking for more respondents for, which is about clinicians and cat owners' experiences of remote consultations. The the consultations we've sadly had to get used to with a COVID and social distancing where instead of being able to see our clients in the consulting rooms, we are typically doing either telephone or video consultations.
And I put the link to that in the chat box, but it's also on the website. There's a separate survey for vets and nurses compared to cat owners, and I would be absolutely delighted if you could participate in that survey. So if we're talking about the senior consult, I think probably is a starting point that's sensible is just to reinforce that message of when is a cat, a senior cat?
And Natalie this morning spoke as a representative of ICA care and included this chart, which you can see in front of you, which I find extremely helpful, not only for myself, but also for my client. When talking about preventative health care screening in older cats, age appropriate tests, because as you will see in this chart, it not only has the life stage of cats, but also the corresponding age of cats and a human equivalent age. And I find that really helpful in terms of translating my advice into Perhaps a way that a carer might understand, for example, as carers, a a sort of gender neutral health screening that happens in the UK is screening for bowel cancer through the National Health Service inviting us to send off a sample of our faeces in Scotland, when you reach the grand age of 50 in England, I think it's when you're 60.
And therefore, I know that all the clients that I see here in Scotland that are over the age of 50 have experienced age-related preventative healthcare, and it then helps me when talking about their cat, to say, did you know your cat that is 12 years old, that is equivalent to a human, age 64 years old, and therefore, it makes it, I think, easier for them to understand and see the rationale behind age-related health screening. And so the cats were, of course, most interested in, in terms of our senior consult are the senior cats aged 11 to 14 years, but also our super senior. This is the the category that was previously called the geriatric cat.
But now this super celebratory, superhero, super senior, which is the cat, 15 years and over. And you'll be able to see more information on iCAT Care's website, and you can download this poster and use it in your clinics. So this is the age group we're interested in, a senior cat consult really is any consultation involving a cat aged 11 years and over.
And I think the key message for me today would be to make the most of all and any opportunities that you have to see your older cats because when we try and set up senior health clinics to specifically recruit these older cats, uptake typically is relatively low. And whilst those that come in are You know, very keen, dedicated owners and receptive to us, assessing their cats and making suggestions. There are many more older cats that just don't come in for those invited checks.
But if they do happen to come in, whether it's for vaccination, whether it's because of a clinical illness, we should make the most of all opportunities to assess the cats and do the best possible job that we can. Why is the senior consult important? Well, as we've heard through today, and as I will reinforce as well, many older cats have clinical or subclinical problems that we can do something about.
And so, there's definitely a lot to be gained by us as a clinician, having our eyes open and seeing these patients, because we may well be able to cure. Any condition that we diagnose, and an example of a curative condition or potentially curative condition would be hyperthyroidism, perhaps dental disease. But even in those conditions that we can't cure, often we can do an awful lot to improve quality of life, and we may be able to slow the progression of disease, as discussed with respect to renal disease earlier today.
Unfortunately, as I've already said, lots of older cats don't come into the clinic very often, and that's the first challenge that we have to face. But if we can make these early diagnoses, when we do have these opportunities to opportunities to see these older cats, then that is likely to be associated. With a better treatment outcome.
And there are many conditions for which that applies, but a nice example I put here was if we can identify systemic hypertension before it has caused blindness in the cat, then we have hopefully protected that cat's eyesight and therefore preserved that aspect of quality of life going forwards. And I find this aspect of veterinary care very rewarding to deal with, and I think many owners are very bonded to their older cats, and also like to be involved in the care and find it rewarding for themselves and their cats as well. Just a couple of studies that I wanted to highlight at this point.
This one is a, it's actually quite an old publication, as you can see, 1998. But just highlighting actually how common it is to find intercurrent diseases in cats and dogs coming in for vaccination. And just concentrating on the cats for, for obvious reasons with me.
You can see that actually at all life stages, it's really quite common to find things that merit further discussion, whether that is obesity in a, in a younger or middle-aged animal, or whether it is perhaps evidence of mobility problems in that aged animal. So there is often a lot that we can pick up on these checks. And a more recent study reported in the Journal of Feline Medicine and Surgery looking at apparently healthy cats, 100 healthy cats in this study found that it was relatively common, again, to find issues that would benefit from treatment.
About half of these cats were senior cats, as you can see, half of the cats were mature cats, so a young, younger life stage. And you can see that all the cats assessed in this paper, 8% of them had high blood pressure. 11 cats, so 11% of the cats had a heart murmur, 20 of the cats had a goitre, and in 3 of the cats that was associated.
With an increased total T4. So often these apparently healthy cats of varying ages in this study, mature and senior cats, quite often will have clinical issues that would benefit from us identifying and managing. I've mentioned already that there are some challenges in terms of assessing our senior cats, and one being that we don't see as many senior cats as we would like to.
But there are other challenges beyond that, and, and actually a question a little bit earlier this afternoon, I think, highlighted at least one of these. We do know that cats, for a start, are very good at adapting to and compensating for all sorts of illnesses. We don't see a cat presenting with anaemia, unless that anaemia is extremely severe, and the cat is.
Now just in an absolute crisis stage with a hematocrit of 10%. So cats are very good at living with illness and just adjusting their lifestyle and their behaviour. And in the case of chronic illnesses, which many of these old cat illnesses are, typically, these will happen very gradually.
And so, therefore, the clinical signs may again Develop very gradually and be largely hidden by the cat, because it just adjusts its lifestyle to compensate for those problems. So if mobility is difficult, then that older cat may now start sleeping at floor level rather than jumping on the bed. It may go upstairs less, use the cat flap less.
And because these changes often happen very slowly, they're really hard for an owner to spot. But also many owners will feel that it's normal to expect these sort of changes. So it's normal to think perhaps in their mind of their elderly cat to perhaps be thin, to perhaps have poor coat condition, perhaps some mats in the coat, and to not move around very much.
And therefore, they may not necessarily seek advice or support if they see those sorts of signs. And clinical signs also can be confusing. And again, this was highlighted in Andy's presentation, where he talked about toileting accidents being a potential manifestation of osteoarthritis in cats.
But from an owner perspective, they might come in and and think that their cat either has Signs of dementia, cognitive dysfunction syndrome, or perhaps the, the cat is incontinent because it's, it's having periourea incidents in the household rather than perhaps, quite understandably, it being due to other issues such as osteoarthritis. So there are plenty of challenges that we face. And from a carer perspective, again, there are lots of reasons why they perhaps might not prioritise things that they do see in their cat and, and bring the cat into us.
They may feel that all these changes are quite normal, that their cat is OK. Why would they bring the cat in to see us? They may also be very that investigations are going to be painful or expensive for their cats.
Many owners also still feel that, well, what is to be gained because you can't cure kidney disease, you can't cure arthritis. So, you know, what's the point in, in, putting my cat through these tests and, and, spending lots of money really for no gain? So a lot of these concerns, which, of course, we would all be able to to counter, be able to advise our clients that actually, there is a lot we can do to improve quality of life, to slow progression of disease, to help the cats.
But these are all potential barriers as to why our carer may not come in. And another thing I've not put on here really as well, but was highlighted, I think, with one of the questions that I In the day, is the impact of stress on cats visiting the vet clinic. And we know that many carers find vet visits extremely stressful for for their cats.
One study reported by Bayer reported about 60% of owners said their cats hated going to the vets, and about 40% of those owners said just thinking about a vet visit was really stressful for them. So all these things are in the background and make it difficult to give us as many opportunities as we would like to see our senior cats. So we need to grab the opportunities to see our senior cats.
And of course, those that have clinical problems, we want to diagnose. And and manage those as best as we can. But in those apparently healthy older cats that come in for a vaccination or an invited senior health check, we really want to maximise the opportunity to identify common health problems which may have an impact on our cat's quality of life, so that we can address these, treat these at the earliest possible stage and support and maintain healthy ageing in our cats as as best as possible.
As Natalie mentioned in her presentation this morning, iC Cat Care have devised some guidelines for life stage appropriate assessment of cats coming into the clinic. And so the next thing that I would like to, to tackle in this presentation is really what that does to our shopping list, our checklist, if you like, of things to do, in our consultation and what the senior consultation, therefore, should look like. And to access more information on this topic, I would encourage you to visit I Cat Care's website, catcareorlife.org, as written on this slide.
So it's a number 4 in the middle of that website. And you can download the checklists, and there is information aimed at carers and and information aimed at our clients. For cats up to the age of 7 years, what is recommended is, I think, very much what all clinics would also recommend as a standard, which is, where possible, our patients should come in once a year and have a thorough history and physical examination and a weight check and appropriate preventative healthcare advice provided.
But once the cat reaches the age of 7, that mature life stage, ICA Care encourage us to at that annual health check, include a blood pressure assessment, some blood profiles, and urinalysis profiles where at all possible. And the urinalysis can be done on a free catch sample. And so, if you're able to, train and educate your clients into collecting that urine sample and bringing it in with them for that appointment, that can be extremely helpful.
And I'll talk more about what we might want to include in our blood profiles in a little while. Once the cat reaches the senior age category, so that's age 11, if possible, assess that cat twice a year, so every 6 months. And on a 6 to 12 monthly basis, include your blood pressure, blood profile, and urinalysis profiles.
And so depending on the cat and the clients and perhaps Your clinical suspicions, you may feel happy to leave that as a once a year blood test at that point, if everything seems to be going very well. But if there are any concerns, of course, then you can assess things more frequently. And you'll notice also that this is the point where IA care recommend a total T4 test is included in your profile, if possible.
And then the last age category is the super senior, the cat's aged 15 years and over, where ICAT care's recommendations are the same, if possible, again, 6 monthly checkups and 6 to 12 monthly blood pressure, urinalysis, blood work, and T4. I think there is good rationale for cats in this age category to have a health assessment every 3 months. And that can be often very well done by the nurses in the clinic.
And really, the intention is the detailed history, physical examination, including the weight check. Again, really, with the intention of picking up those common old cat illnesses at the earliest possible stage. It's all about keeping in contact with your clients and their cats.
It's hard work to run these sorts of assessments, and if you're not already running this sort of plan in your practise, you may be looking at this slide, thinking of the number of cats you see that are in that mature senior and super senior age groups and thinking, well, this really is would overwhelm my clinic instantly. And I can definitely identify with it, but I do think that's a really good intention to aim for. Your 7 to 10 year old cats are going to be generally healthy, so that's often a baseline period.
Some cats will start to develop health issues during that time point, though, so still very much of value, I feel to do the ICA care recommended tests at that point. And it also can be helpful, really, to explain to your clients what sort of health problems you are looking for and the relative frequency of these. So the prevalence of different conditions.
So they have an understanding of, well, how likely is it that my cat may develop one or more of these possibilities. And whilst we don't always have as good data on prevalence of disease, in general, we do know that chronic kidney disease is very common. So Jonathan Elliott shared some figures from his studies a little bit earlier today, and there are other figures elsewhere, but certainly often people would say, you know, maybe a third of our senior super senior cats are likely to develop chronic kidney disease.
About 10% of our cats. Aged 10 years and over, develop hyperthyroidism, diabetes a little bit less frequently seen and involves often includes our our middle aged cats as well as our elderly cats. High blood pressure probably affects about 20% of our senior cats overall, but it is in particular, we see it in association with chronic kidney disease, where perhaps up to 60% of cats with chronic kidney disease also have high blood pressure.
Osteoarthritis also has been talked about already today, and some studies that indicate more than 90% of senior and super senior cats have radiographic evidence of osteoarthritis. Whilst that might not equate to more than 90% of senior super senior cats needing painkillers, certainly a significant number of them are likely to be suffering from some mobility problems that might benefit from management. And lastly, cognitive dysfunction syndrome, that the cat equivalent of Alzheimer's disease, also extremely common.
So more than 25% of senior cats, more than half of super senior cats. So, really, any old cat is very likely to have multiple issues, and the older it gets, the more likely it will have at least one of these issues. So if we look at a sort of, I, I think a typical example of a senior consultant where we can really optimise what we might get out of it.
This is a patient of mine called Harry, a 17 year old male neutered, tabby domestic short hair, that came in for a boost to vaccination, so he's not coming in because of any concerns. At home, he has a very routine background, but he's here for his senior consult, his health check and assessment. Well, first of all, of course, we want to take a thorough history.
And in our older cats, there are certain things that I think really we do absolutely need to to ask in our our questioning. So a general history, of course, goes without saying. But the extra questions that are relevant in our senior cats include questions over mental status, behavioural changes, cognitive function, which of course can be impacted by a number of illnesses in our older cat, hyperthyroidism, hypertension and cognitive dysfunction syndrome, to name just a few, visual deficits, which have a relevance, obviously with our our hypertension, mobility issues, and I'll come back to the questioning for that in just a moment.
. Because we know that's common. Perhaps toileting accidents bring up that subject as well, because, sometimes carers are, perhaps reticent to mention these things up front. And then, of course, the, the very obvious things like eating and drinking and weight loss, where the owners are aware of that.
As with Andy and his orthopaedic assessments, I, I do find owner questionnaires helpful. And I have created a questionnaire which is free to download from my website. There is a section of vet professionals, which is called Helpful info, and you will see on Beneath that, one of the subsections is called free downloads.
You, you do, you're asked to register to access that area, but it is free and completely GDPR compliant. So there is, I think, no downside to registering, and you'll see a lot of technical guides and documents that you can download, including this one. Which is a questionnaire for health in older cats, and it includes general questions.
So have you noticed any change in your cats? We have thirst, appetite, eating, breath, weight, so on and so forth. And then on the right hand side of this side are some of the mobility questions, which very much similar to the feline musculoskeletal pain index, developed by Dun.
Lassals and colleagues, which was referenced earlier on as well. But just ask questions about jumping, using steps, using the cat flap, evidence for stiff or stilted gaits, any clues of chronic pain, such as the cat being grumpy or less happy or more withdrawn, all these sorts of things. And I think a really big utility of, in particular, the mobility questions.
It's not only in identifying problems, but also, actually, we're, we're now telling our clients what to look out for as possible indicate. They see problems in their cat at home. And often what I find when I run through these questions is that, on the first occasion I run through these questions, and the client has never been asked them before, often they will say, Well, no, I think everything is fine.
My cat, loves sitting on the kitchen window sill, or they like to sit on the wall at the bottom of my garden, you know, various little anecdotes will come out. But then they will go home and they will retain some of these questions and start to often look at the cat a little bit more closely, perhaps a little bit more critically. And often the next time I see them, they will say, actually, I have spotted that my cat only now goes on the kitchen window sill if there's a chair next to it, and he jumps on the chair first, and then the window sills.
So he used to jump all the way up and all the way down. That's, that's changed. And so, in a way, I've, I've helped to sort of point them in the direction of what to look for and what might be helpful in identifying mobility issues.
For Harry, his owner said, as we were walking through the door, how are things? You know, just the general hello and chit chat. Oh, he's a bit stiff, and, and he's definitely drinking a bit more.
But actually said in a very, oh, you know, we're not worried. We're expecting you to dismiss these, to, to old age. And we almost wouldn't have mentioned.
If you'd not asked. So again, the history is, is really important to try and understand as much as possible about our patients. And then, of course, we want to assess our elderly cats, where possible, witness their gates in the consulting room, and that, of course, can be challenging, but I'll, I'll show you how I do that in just a second.
The first hands-on thing would be a blood pressure assessment. We want to do that with our cat as calm and relaxed as possible, having had ideally, at least 5, if not 10 minutes during the history to sort of settle in the consulting room before we start that procedure. And then, of course, the rest of Examination to look for any other evidence of problems and, and make sure we do things like feel for a goitre, listen for that heart murmur that might be found in a cat with hyperthyroidism or hypertension, examine the eyes for hypertensive problems and so on and so forth.
So in terms of the mobility assessment, the clinic that I currently have links with, develops, I think, an innovative solution, which is that, in their first cat room in the clinic, what they did. Was to build some steps into the side of the wall of the clinic, as demonstrated by Cleo here and some still images. And the idea was that hopefully that would facilitate some sort of mobility assessment in the consulting room.
And of course, it's not a force plate. It's not, you know, it's not a scientifically, clinically proven mobility assessment that you're, you're going to get. But in actual fact, the steps do work quite well.
So after weighing the cat, the cats, if it's an older cat, typically will choose to come down the steps, and this cat, cookie, you can see is a little bit. Resident, having a little think, a little bit slow coming down. Young cats typically will just leap off the the worktop onto the floor.
But the old cats of unprompted will come down the steps. Sometimes we do have a little treat at the bottom, sometimes we have the cat's carrier at the bottom. But most of the time, they will actually just come down all on their own.
And sometimes we will see really severely affected cases, and I, I hope this is projecting adequately, but this cat, you can see, enthusiastic to come down the steps, although she does eventually stop because it really is just such hard work. And in her instance, really, her carers were not aware of any mobility issues at home. But to us in the clinic, watching her come down the steps, she looked very disabled and actually playing that video to the client was helpful in terms of some of the discussions.
And indeed, just having steps in the consulting room, I have found really helpful because the clients always ask, Well, why do, why are there steps there? And the reason obviously can be explained, and it helps open up question of mobility problems in cats. Sometimes we do have cats and, and this is one of my patients, Sunny, who just sort of studiously sits on the scales and, and, yes, I can see there's some steps, and you might have a treat at the bottom.
You might even have my carrier. But, no, thank you very much. I'm just gonna stay at the top.
So it's not always possible to get This sort of mobility assessment, and almost always, even when the cat will go down the steps, they won't go back up again. So I think I've only had a handful of ever gone up the steps. But nonetheless, as I say, I think it's a, it's a useful little innovation, and that doesn't take up much space in your consulting room.
The first hands-on thing I mentioned we would want to do would be our blood pressure assessment. There's lots of extra guides on my website to support advice on how to assess blood pressure in, in cats, in the free downloads, but also the video tutorials. There are some webinars and, and videos on blood pressure assessments.
When it comes to eye examination, In which Natalie mentioned earlier today as well. I'm a big fan of using a hand lens and a light source, and you can get hand lenses, acrylic hand lenses for about 40 pounds, so not terribly expensive, and use your direct ophthalmoscope as a light source, so something that you already have in your consulting room. And the advantage of that is that with the light source, far from the patient, I'm holding it in that bottom photo, the light is by the side of my head, but in the dark, which is how you would do it, obviously, but doesn't make a very good photo.
The light is quite a long way away from the cat's eye, and therefore, the pupil doesn't constrict, and you get a nice view of most of the back of the cat's eye in one view, and can quickly see, certainly, if there's blood or detachment, it is, it's pretty obvious. And that's then tells you absolutely you need to measure blood pressure in this cat if you've not already done so. Again, it goes without saying to weigh, to assess body condition score, to assess muscle condition, potentially calculate percentage weight changes in your patients.
And hopefully, that is something that, that is just normal and natural for us to do anyway. But there have been some really nice studies that have highlighted just how valuable something as simple as a weight check can be. And this is a study that was published a few years ago, where more than 500 cats diagnosed with chronic kidney disease, the researchers had access to body weight data from those cats, not only at the time of diagnosis, but actually going back for several years.
And what they found was that the cats lost a median of 8.9% of their body weight in the year preceding diagnosis, a huge amount of body weight, the equivalent of of perhaps an an average female weighing 10. Stone, losing almost a stone in body weight in that year preceding diagnosis, but also that, in fact, that weight loss often was already present several years before that point as well.
So if you actually look through the records, you could see the cat had been losing weight. And those cats with the, the lower body weight at the time of diagnosis had a shorter survival time. So perhaps an indication that if we can make an early diagnosis, we can get a better treatment outcome.
So when is weight loss significant? Well, I think if there is a downward trend, and that's not something that you have been wanting, in other words, your patient is not on a weight loss regime and you're just doing a brilliant job. If there is a downward trend in weights, that, that is, you know, not Due to any intervention on your, your part, then that is significant.
However gently downward it is. Looking at percentage weight changes can be helpful, and I'll show you that on the next slide. But also, if our patients have lost muscle mass, then that is definitely an indication for concern.
Looking at percentage weight changes can be helpful if you perhaps only have, you know, one previous reading. You've not got lots and lots of data to go on, and you're wondering, well, is this change significant? And, and if the cat perhaps is only coming into the clinic, a couple of times a year, then I think this is, it's a really valid way of, of assessing the change in weight and deciding whether or not it is significant.
To calculate a percentage weight change, it's the difference in the weight. So today compared to last time, divided by the original weight and then multiplied by 100%. And my approach to looking at significance is that if there is less than a 5% change in weights, then that is difficult to know the significance of, and unless there are other criteria for concern, I would probably monitor that cat.
But if they've lost 5% or more of body weight, then I, I would view that as a very significant. Even though in absolute terms, this is often a relatively small amount of weight. So 5% weight for a 4 kg cat is just 200 grammes, and you might well, how much does a full bladder and a full colon and a full stomach weigh.
But I think over the years, this has seemed to work out as a sensible parameter to a sensible sort of benchmark to use. And in fact, if you convert that into an adult person, then you can see that a 5% weight loss of, of someone who weighed 65 kg or about 10 stone, is half a stone or more than 3 kg. And we don't, our weight does not fluctuate by several kilos every day.
It's, it fluctuates a little bit. But again, that helps to, I think, put, put some significance onto it. This is just the tail end of my questionnaire that I, I showed you a little bit earlier and just a reminder of things to do in the consult and you can record the data in terms of body weight and blood pressure results.
So if we go back to, what we found was that although his owners actually have not been very worried about him at all, he's, yes, he's a bit stiff. Yes, he's drinking more. He'd actually lost a huge amount of weight, 13% of his body weight, a massive amount of weight, and they've not noticed it because it had been very gradual.
And so that's just something that we need to understand and be aware of, that gradual weight loss is difficult to spot. But he also had a heart murmur that was new, previous, assessments on, on the record system, there was no mention of a heart murmur. Bit echocardic.
So we've now got really very definite things to worry about in him. And of course, differential diagnosis for the that combination of of clinical signs and physical examination would include things like hyperthyroidism, although no goitre palpable. Also systemic hypertension that commonly results in a heart murmur due to cardiac remodelling.
And in fact, when we looked at his eyes, although he was perfectly visual, no visual deficits, he had quite widespread abnormalities on his fundus, including some areas of retinal edoema, these sort of green circular areas on his retina, and also an area of retinal detachment, which I've put within a circle on this slide here where you can see things are out of focus because they're closer to the camera, but we can still see the vessels. It's a serious detachment as opposed to a bloody detachment. And you do also get the impression that his vessels look a bit more tortuous, and his vessels are varying in diameter, which are consistent changes with systemic hypertension.
And his blood pressure was measured, that too was extremely high. And although just a single occasion that we've assessed his blood pressure, because he had a high reading and evidence of target organ damage, we could diagnose systemic hypertension. So already, Harry, who came in for his vaccination, from my perspective, I'm just absolutely thrilled that he came in at this point when he still can see, he's not bumping into things.
I can now start treatment and protect his eyesight. For Harry, of course, there's a priority to, to do further invest. He's lost weight.
We, we want to understand what's caused the hypertension, what's caused the weight loss. But in any case in our senior cons, we do want to do, where possible, some urinalysis and some blood work. And as I mentioned at the beginning, for our screening of, of healthy cats, actually a free catch sample is perfectly acceptable, and many Owners are really very good at getting these samples, using kits like cat core and equivalent, collecting a sample at home.
The older the cat is, the easier it tends to be to get that sample. They tend to not mind being confined with a litter tray. And of course, if they are polyureic polydipsy, they will use it fairly quickly.
We'll get our sample. And really, we're just interested at this point in doing a specific gravity and a dipstick. And there are downloads on my website and also video guides to collecting urine samples from cats, both for owners, the free catch, and also cystocentesis.
Very basic interpretation of our urine specific gravity, a very quick and easy thing for us to do. And of course, we can do this also without the cat. So if our owner has concerns that the cat is perhaps drinking more, we can ask them to drop in a urine sample even and assess it.
What we're looking for is really for that urine specific gravity to be at least 10:30. 5 as an indication of good concentrating ability. And I tend to say, well, 1040 and above is is normal and no no further action required.
If it's less than 1035, that is definitely abnormal, unless the cat is receiving diuretics or it receives a completely liquid diet. There's some other reason why it's your in specific gravity is so low. The main differentials would be kidney disease, thyroid disease, diabetes mellitus, and we definitely want to do some further investigations on that cat.
And then I tend to put those cats with the USG between 10:35 and 1040 into a little bit of a keep a close eye on these cats group, the borderline results. And if everything seems OK today with the cats, there's no weight loss, no other clinical signs, then I would like to monitor that cat and, and certainly leave it no longer than 6 months till the next check. But of course, if there are any other indications of concern, then I will go straight on to recommend further investigations.
Similarly, our blood tests, if we're able to follow the ICA care guidelines and do blood profiles in our healthy cats, then the main aim of these is to look for the common problems, and to rule out things. Like kidney disease, hyperthyroidism, diabetes, and so on. And we can look at trends and results if we do have serial results and we same laboratory, and ideally do as thorough a blood panel as you can.
So in ology chemistry, if possible, your IDEX SGMA because as has been talked about today, that can be more sensitive in diagnosing early renal disease and certainly in cats age 11 years and over a total T4 wherever possible. If doing all of that is, is perhaps not affordable by the clients, then what you might do as a pre-anesthetic screen is definitely gonna be a very good start. And if you do find, for example, that the liver enzymes are increased, then try and do a T4 test to, to follow through from that.
And initially, as I've mentioned with the urine analysis, really it's the specific gravity and dipstick that are our starting point in our, our baseline. Further tests might be indicated if we find abnormalities. For cats like Harry, where we have obviously found problems that that we're concerned about, then the priority really for him on this occasion is to start treatment for his hypertension.
His blood pressure is very high. It's already causing target organ damage. We want to bring that under control as a priority.
And then once stabilised, where at all possible, look for conditions that may be associated with that hypertension, such as chronic kidney disease, but also don't forget about the other issues that, that have come up through the history, such as the fact he's more stiff, his mobility appears to be impaired. And in his case, won't come as a surprise that having had this initial problem list from our history and our physical examination, we made some major diagnoses, which were primarily chronic kidney disease and systemic hypertension. We made a presumptive diagnosis that his mobility issues probably related to osteoarthritis.
We didn't perform X-rays to to confirm that. And so, having come in from it for his vaccination, ultimately, this is now, obviously a little while later, he had treatment for his hypertension, which was very effective. He transitioned on to a therapeutic renal diet, which led to an improvement in his body weight.
And whilst he hadn't been showing clinical signs that were apparent. It was lovely to see that he did gain that weight there. And we also did a lot in terms of his osteoarthritis management, initially concentrating on environmental modification, and starting with some joint supplements with the options of, further dietary modifications and painkillers in the future.
And I think the main lessons really for, for Harry are to make the most of those opportunities when we see those older cats. And he could have been a tempting opportunity if you're having a busy afternoon clinic and running a bit behind to just, you know, rush through the vaccination appointment. But happily for Harry and, and I think We were all delighted, really, that we were able to make these diagnoses at a point where his quality of life was, was not massively impacted, but we were able to improve his body weight, keep his eyesight, keep him visual without that worry of hypertension causing blindness, and really maintain his quality of life.
Weight check, really the simple thing as well, that was dramatically abnormal in him. So make sure that you do monitor and record those weights as, as has been spoken about today. And then just very finally, a few little tips as well that might be useful for our owners of healthy older cats in terms of things if they're particularly keen and committed cat carers that that might be of interest to them.
One would be to invest in some scales for home weight monitoring, and I think particularly at the moment with COVID limiting our ability to see our patients sometimes. If owners are able to monitor body weight at home, that provides us with lovely objective data on how a patient is doing, and you can get get in expensive scales designed for, for children, typically babies online, relatively, relatively easily. Older cats often do well from help with grooming, cephalic ocular and nasal discharge management as well, keeping an eye on their nails, which often, you will know cause problems in older cats.
But again, if owners are able to look out for that, that helps. I do think all senior cats should be offered a litter box, because, I think it's the kind thing to do. Toileting accidents definitely more common in cats for a range of reasons.
If our cat has arthritis and it's painful going up and down stairs, using a cat flap, going into the garden, digging in the soil in the middle of winter, then offering that litter tray with a fine sandy. Consistency, clumping litter would be my recommendation because then we can also monitor the number and the size of, of urinations per day, which is useful for diagnosis of things like kidney disease and constipation as well, knowing how often the cat is passing faeces and subclinical constipation is, I think, relatively common in cats with kidney disease as well. So a lot that we can do to to help support these cats, and help maintain their quality of life.
And lastly, from a cognitive function perspective, really keeping life interesting. So allowing that, that cat to have that window to look out for, you might have to have some chairs and steps to facilitate their access to that point if they have mobility issues, having some toys to play with, having some time outside, all help to, to maintain cognitive function and quality of life. So I hope that's been of interest and, and of use.
I'm, I'm sure it will resonate with the cases that you see. You all will be seeing lots, lots of old cats as well. And I do think they're, they're lovely patients to treat because often we can do an awful lot to really improve their quality of life.
And just a reminder of my website and some of the resources that are available to you. So, particularly on that helpful info menu, the free downloads and the video tutorials, there is a huge amount of information, videos and webinars that are completely free to access. So I'll be delighted if you would use them and feel free to share with your colleague.
Thank you very much.
