Hello. It's, lovely to be back. And we're gonna continue thinking about our old cats with behavioural changes.
And we're even gonna use the same cat. So you're gonna have to remember what she was doing. No, it's OK.
I'm gonna, I've got to introduce you to her again. But this time, we're gonna focus on feline osteoarthritis. Now, remember, I am not a surgeon, so I am not going to be talking of anything cutting.
But to be honest, you do not need to be a surgeon to discuss. Fey osteoarthritis. Actually, what you need to be is a fiophile above and beyond everything else.
So let's. See, there you go. So to remind you about Sally, let's have a pointer.
Can I do a pointer? No, looks like I can't. Hopefully you can see my, see my point.
OK. So Sally, she's our 16 year old, female neutered, Maggie. She's aged a lot in 2 years.
She stopped grooming, as you can tell, and she's urinating, outside of the litter box, although she is peeing, sorry, she's pooping in the box, so just peeing around the house. And crying loudly, at night. And it's a pretty nasty, wow.
It's a real, I'm not gonna do it very loudly because I'm in work. I'm not upset a real you know real it's hot, you wake up straight away and go, what is that? So, not, not a good set of things.
And, and you can see from looking at her, you don't need a physical exam to be able to see there's something wrong with her back and the way she's standing and the way she's holding her tail. So it looks like we've got arthritis similar in her back, possibly her hip, definitely her stifles. I would be tail, yeah, I think the the top of her tail, maybe her elbows, a little bit too.
All of those things need to be considered. And while her owners weren't worried about her being on the skinny side, when we looked at her notes. Oh, slow eight loss.
I do apologise, that's clearly supposed to be slow weight loss. She's 20% in 2 years, which actually is really important because mammals, unless you're hibernating and all, all the, all the other caveats, but the normal standard, once you've got an adult weight doesn't normally alter that much. And certainly to lose more than 5%, even in a year, is worth investigating.
And 20% says, we are quite worried about this, very worried about this. She's skinny. She's a little bit dehydrated, but you know what it's like, it's gonna be difficult to tell with that with elderly cats, they've all got a skin tend.
She's a little bit tachycardic, and she's got a, a little murmur and an occasional gallop, of course, far more important than the, the, the 2 out of 6 murmur. She's got a little thyroid slip on the left. Significance or not, we're not sure at this point.
And yeah, physical exam, you can find signs of arthritis, stifles back, hips, and elbows. So problem list for this little girl, she's definitely got arthritis. Got to put that right at the top, definitely.
But that is unlikely to be causing weight loss, unless it's, she can't get physically get to where her food is. You know, if she's used to being fed on, on a sideboard, she can't get there, but now the cat can, yes, you. Result in that too.
The peruria, absolutely, she's got a high sighted litter box. That would be a, a, a, a good reason for periuria, it's not gonna cause the, the cardiac things, and it's not gonna be causing this altered this crying and, and, and changes in behaviour. So, let's have a think about those, think about the most important ones, arthritis.
So it's quite interesting. Let me look at the middle bit, the owner list. And this was an original study by, my good friend Vicky Halls.
She's a favorist, and we published this, with Lauren Solo, my, my brilliant PhD student, nearly 3 years ago now. We asked owners what were the chronic diseases their cats lived with. And arthritis came up first.
They recognised it in 40% of their cats. Now we know it's more frequently occurring than that, but the point is that owners can spot it in 40% of cats. Dental disease was a little bit lower and kidneys, hyperthyroid deafness.
No diabetes is way, way down the bottom. Interesting. That's another talk as they say.
In a, in a vet list, then we would put dental disease higher than arthritis. The owners put it the other way around, and I do think that's important. How common is it?
Well, I think it's important to mention spondylosis deformance, what we used to call ventral spondylosis. This is a form of degenerative joint disease, but it's not actually osteoarthritis because they're not synovial joints. This is seen in at least 80%.
Cats, over, over 12, so definitely, in, little Sally's case. And it definitely contributes to stiffness. And then this lovely paper came out, 10 years ago now, and these cats had a poor quality of life, uncomfortable.
Unwilling to be petted, even to the point of aggressive. So doing something to address this is important. And it's important to remember that we're talking about the, the, the bony growths, on the underside of the, the, the, the spine here.
But if we look at the, the, the facet joints on the top, these are actually, osteoarthritic changes. So these are actually synovi. So prevalence, what I find is fascinating is that even cats as young as a year.
I got a third of them have got arthritis in one of their joints already, at least one of them at a year old. And by the time we're looking at cats older than 12, and 90%, some people would say. And yes, some.
Reed breed breed predispositions occur, can't speak, and Maine Coons biggy. Some studies have said 50% have got hip dysplasia, often patella laxation as well, also seen in Persians and Siamese, whereas patella laxation is particularly seen. Abyssinians, put, Bengals in there very much and in different rexes, and then Scottish folds and all of the things are mess that is that.
What is fascinating and concerning, we need to put this in when we're thinking about treatment, is that there is some epidemiological association between chronic kidney disease and osteoarthritis. OK, yeah, they're both in older cats, but it's, it's more than that. Is it that inflammatory going on in the joints is that getting into the kidneys and causing secondary problems there?
Probably. But it is, it is an important consideration. So whenever you diagnose arthritis, you do need to check for kidney disease before you consider .
Treating. And the most common joints, we're talking stifles, bony growths here, elbows with extra bone, hips, not that much arthritis, but a hip that's not even vaguely in place, more arthritic changes there, menstrual ventral spondylosis. And it's important to remember the tarsals and carpals as well.
Because most of the original studies only looked at the the the body without the legs, and if you include the leg then you do find arthritis in the copy, but also remember the tail. Can develop arthritis as well, and can that can result in significant pain. So it is different.
The dog is mainly idiopathic rather than, primary to due to genetics. So most of the cases, 70 to 90%, it's some primary degenerational low grade trauma, you know, low grade mala mala. I can't speak.
We do know that obesity, we see a little Maya down here, is a very significant increased risk, and she is a Burmese, and of course she's increased risk of diabetes, which she also has. And if you look at Burmese elbows, by the time they're about 8 years old, you're gonna find these enthesophytes, which is mineralization of the tendons and. Fromma, this little cat in the middle was called Tripod.
She didn't have a second back leg car accident, and at the time of the car accident you can see she's had significant bleeding into this week and next. By way of infection not common. We do see some mycobacteria, so that would be the most commonly, occasionally mycoplasma, but not, not common.
And obviously, lifestyle, if you're an outdoor cat, anti-duty fishing candy cat, you're more likely to have trauma than being a house cat. Talking about hip dysplasia, I just wanted to, to mention the predispositions. Mostly, it's just a chance to show you my beautiful, beautiful boy.
This was, my gorgeous mla. These are his hips, when he's a one year old, this is when I first met him. He got referred in to have bilateral tibial crest transpositions because of his, medial luxating patella.
And you can see his hips are are barely in the fossil at all. This year is, yeah, I know. These are effects by the time he was 4.
This is him by the time he's 17. You can see he sleeps with his hips, his legs in a very straight position, and he often puts a piece of a rug or a cushion or my arm between his ankles that seem to take the pressure off of his hips, and I've known other Maine Coon owners say that their cats do that too. Oh, there you go, I forgot I put this slide in.
There's my gorgeous boy showing how he's much more comfortable to sleep like that. I know, it looks very strange. That's so made him his prime.
And then this is he's 17 in this picture, you can see he's got elbows that go out and then wrists that the curve. We describe them as queen and chair legs if you are into the history of furniture that kind of make you elbows go out and then wrists twist around. And if I can, if you can, zone out up onto this, that then please do.
This is my where my beautiful boy is now. And if you hone in on his, on his patelle, well, they're not there. Every single bone is here, every tiny little toe, toenailed a lot.
Well, you know, bony bits of his toes. But it's not his patelle. They had actually so much damage and disease in them that they'd just turned into sludge.
So that shows you that this is not the same cats and dogs. There's a picture there of how my world works. You are less likely to see very overt signs of lameness, obvious joint pain, joint soft tissue swelling of joint, or altered, movement.
You're much more likely to have subtle signs. And the most important ones are reluctant to jump. So you have to ask, is the cat?
I know this cat pictures distract to me, that's the ninja cat. Thank you, thank you, . That reluctant jumps it is the cat.
Is it still jumping as high as it used to, but it's maybe taking more bum wiggles before it can get up there? Or is instead of going straight to the top of the table, is it just now jumping onto a chair before it gets onto the table? Those sort of questions really, really important and the same thing jumping down.
Other things I'm not gonna do, playing, grooming. Definite problems with problems with the litter box. Imagine you've got a house soiling whether it's urination or defecation.
Increase risk of constipation because it's harder to posture, and when they, when they're pooping or peeing, they can't get them on down so sometimes that the urine or faeces will fall out fall out of the box because they just can't get their butt low enough. It would be the point that these cats are, are really, really miserable that they're interacting with people that they not that. Very important one is to get owners to look at their pussycats' feet and be aware of them.
If they're a cat that won't let them look at their feet, then ask them to listen to their cats when they're walking on a hard surface, you know, in the kitchen or the bathroom. And if you're hearing clicking, you know, the nails hit the, the. Floor surface, then the nails are too long.
And it's really important that the cats are then brought in to, have the tails clipped. There's two nails on the side. This is the same cat, this is snowy, and his owner, very elderly lady, she was, oh, brokenhearted when I showed her this.
She said, But why didn't he tell me? He must have been so sore. And I said, Well, he could only shuffle because he's got problems with all four bores, and you can see just how long those toenails are.
And he has another little elderly cat this is Poppy, and you can see the way all of her, her toenails grown into her paws. This is oh, got to be very, very uncomfortable, painful. And not surprisingly, difficulty manoeuvring the cat flap.
Maybe they're scared to go out because there's a bully thug cat out there, but is it that actually, just getting their arm up to get it out of the cat flap and moving their legs in the position you need to get to do to get out is just too much. And those long toenails can get up caught in carpets and rugs and this can be wrong because that's gonna tug on the, the joint when the cat tries to, you know, extract its nail, and that's gonna add to the pain. And this was a magazine.
It's called the Veterinarian in the States. And my friend Petra Serna spotted it and sent it over to me. I thought it was interesting because they've got the clinical signs as related to the veterinarian and the owner.
When you've got vets, then we all have learned, yep, hesitancy jumping up and down. Reduce mobility, absolutely, problems doing steps, decrease grooming, difficulty getting up standing, yeah, temperament changes, sensitivity to your pain, . Yeah, we know this, that we've learned.
But the owner's note. But the cat's less active. That's an interesting one, isn't it?
Cause I mean, it's not always something we ask. Less willing to play. And then the change is jumping.
So it's important to be aware of what we are looking for and what owners are looking for. And then this paper by Entomoto and obviously this is one of Duncan's group, he's done so much fabulous work on this. We were resident mates many, many years ago, and he whittled it down to, does you can't jump up.
Or down And does it do it normally, climb the stairs up or down? Does it do it normally? Can it run?
Can they chase? And you don't need to ask this massive long questionnaire. You can just ask that, and that will give you some good results.
So these are called clinical metrology, I can't say metrology instruments. They're questionnaires that have been validated. The other thing that has been done, and certainly Duncan's done this quite a bit, adding accelerometers.
See whether or not when you start giving analgesia, that the cats start moving more. And really to help in our diagnosis is that the owners to take a video, get them to bring the video in the clinic when they're bringing the cat, because as we all know, the cats just so many don't want to walk around, and some that were 100 claim will walk completely normally, in the clinic because they've got enough adrenaline on them. And all the different companies that have skin in the game, so to speak, have got resources for this.
So the sweetest support, I really like this one. So you've got joint disease and how they do things and then healthy versus joint there you go, jump right up. This one kind of having to hang on the edge.
Oh, it's harder to get up so. Can be really useful, and then you can, you can grade them, and that can be really helpful and if you send these out when you are sending out your vaccine reminders. Then you get the owners to complete these before they come in.
We've all got used to completing things before, coming in to doctors, dentists, etc. Etc. And they're going to be ticking boxes and realising, oh yeah, my cat has arthritis, and they're gonna be coming to you saying, yes, I think my cat has.
The most important thing is art, mobility, activity, grooming, temperament. Don't just presume the cat is old because the owner might resume that and they're gonna, yeah, I know she's a bit arthritic, but they'll go there's nothing that can be done, there's no point me bringing it up to the vet. It's our job to ask.
So, yeah, how do we diagnose it? You do not need radiographs. If you're sedating for any other reason, then yeah, take some pictures.
Prove it. But just look at the cat walking and hold the cat's joints. They tend to be big and bony thickening, not the soft thickening get the dog, much more hard, bony thickening, and, yes, altered range of movement and some.
And I'm not saying that meloxicam is the answer to all of them. No, I'm not. What I'm just saying in this study, when you add together the cats with a marked improvement and a moderate improvement, 75% of these cats had an improved quality of life.
It behoves us. We've got to ask the questions. If we don't, we are leaving a cat in pain.
We are leaving it, not being able to fulfil so much that it could be fulfilling. So we must, must, must ask about these questions. Ask about changes in dementia, dementia type signs, ask about arthritis signs.
And then, what about therapy? What can we do by way of interventions? Well, some really simple ones.
Early on, if they're getting a bit too chunky, this was my card do when he was, about 10. This is a very old photo now. This is a ball which has got his biscuits in it, and he's got to push the ball around to to get his biscuits.
So a little bit of increased, movement, reduce his, his girth. And of course we've got diets to help with them. With, with more like, by the time, he's 15, he's needing massage.
He used to get really bad cramp in his legs. The first time it happened, he was lying on my tummy. We were just watching movies together, and he just cried, and, kind of fell off, my, my lap and then staggered around.
I was trying to work out what was wrong. And then I realised it was his leg, and I, I can't spontaneously break a leg. And then I was feeling it and realising that it was a spasm.
And I started rubbing it initially he growled at me. I was like, what do you think you're doing? This is sore.
And then he tried to. He went, 00, actually, yeah, that's quite good. You can do more of that.
And from then on, whenever he got the spasm, I was in the house, he would come call to me and, and make me come and sort it out. Remember warmth, this is one of these snuggly beds that you put a a microwaved heater, you know, those discs in and warmth can really make a difference to an old cat on a cold day. Then it's the case, let's look at our environment.
There's so much that we can do and It seems that we're only just say, you know, we're not doing fancy diagnostics. How do we charge for this? You must charge for your time.
Because people don't have these ideas spontaneously. You need to think about your key resources, food, water, some kind of litter box, beds, hiding places, or ways to get away. And I'm gonna add in, climbing frames, you know, some kind of neat scratcher, toenail scratcher, although obviously with caveats.
So we need to try and keep all of these things on the same level, or if they're on different levels, such that they can can easily have access to them all. We don't want them to be jumping with sword joints. Lots of soft warm bedding, but not just gonna catch the toenails and shallow litter boxes.
Let's start by looking at food. Here, we've got blue, brick one. This is, she's the Duane, and, and she's 14 in this picture.
And she's got elevated food and water. I know, they shouldn't be next to each other, ideally. Ideally, they shouldn't be in against the wall.
But what is ideal is they've been lifted up and you can see how much more easily alo is gonna drink and eat when she doesn't have to put pain on her elbows. But if you're at a desk, put your hands, brace your hands on the desk, and then drop your head, so you're dropping your head to the keyboard and feel the pressure that puts on your elbows. If that's what we're asking our cats to do when they're eating and drinking.
And if your elbows are sore, that means you're not going to eat enough. You're not going to drink enough. So the first thing we need to do is make sure they have access, and that might mean just lifting up the food and water.
Hey, we've got nanny, as was Tenny, my little girl, and, initially I wasn't sure whether she would appreciate a raised bowl, so I just did it on a plastic tub. It kept falling off and so I've got her a proper raised, raised bowls, and that's not food and water, that's food. And then this is Bailey.
He's got a very posh. And then water, so important. There is my beautiful, beautiful, more like this is always.
Upsets me saying this, it's, I think it's important. This is the day before I had to put him to sleep cause he finally, he had a seizure. He had umm cell disease.
But he's looking at me because I, I'm taking a picture, but he insisted that he had to go into the sink to, to have a drink because that's where he liked to drink. So if you've got a cat that, that wants to drink, then you've gotta have chair access. You can see there's a chair directly, in front of them, the sink, the sink.
This is a little cheaper art bag, my, my little girl that I had at the same time. A, a bowl that's quite wide but not wider than 15 centimetres, appears to be ideal, and you fill it up as high as you can. That made her very messy cause she always drank on the upper meniscus, but the meniscus on the far side, so you'd get a lot of water around it.
So, yeah, hence the bowl in a bowl, and oops, sorry, that's me. I've actually moved that so I could kneel down. It wouldn't normally be have food there.
And other cats got preferences to what they drink from and you need to make sure that they have access to them. Litter boxes, so it's very shallow litter boxes made out of a tray, can be very helpful for really old cats. This is our litter box at home.
It's very, very tall. It's a Maine Coon box, huge, very tall at the back and low at the front. And that means that even, an arthritic old cat can't get their, their tail very, very low to the litter, it is low enough to have, more not pooping outside the box.
And obviously this box is, is wrong because yes, that's easing the cat to get into the box, but how does it get back out again? I know. And then I thought, yeah, I can tell, what was the, the, the feline love of my life.
So here he is at 14, and this is his toy box. And it was at this point when he's 14, he realised he couldn't jump onto the bed easily and beds are very tall. So I just put his toy box there.
That worked well until, see, now we need steps and my friend John made lovely steps, but eventually, Mort fell through them. And then this was an emergency. Things I called John.
I said, Mort fell through them, please, what can you do? And he's come here straight away. So this is, this is Mort and Sheba.
I've lost them both now. Mort's 18 and, and she were at 21. And Mort was still in the picture, but sadly not in this picture.
And these are the beautiful steps that John then made for me. Each step. A cat can sit on, and each step goes well underneath the step above, so no elderly cat can fall through.
Other things have been suggested, night lights, those can be very good for cats with dementia, they can be quite soothing or appear to be. And people talk about using ramps. Now, you might not know, but I'm disabled.
And actually, When you're on a, a slope, it's really difficult for your pro receptive sensors in your joints to feel safe. So actually, an elderly arthritic cat is not going to feel safe on ramps. They're gonna feel much, much better on stents.
It's just the, the, the security is much better. And then these are just examples of, of family and friends, top, these were three cats, one of which has got bad arthritis, so he needs this climbing frame to get there. Got lovely all sorts of little steps here.
This was little Daisy is up at the top here. I know that's very, very steep, but she did seem to manage it. There's a nice pair of steps to get onto the armchair and then little sky, Sky is 21 in this picture.
I know that's a bit steep, but again, she seemed to manage that well. It appears there's easier steps up to the century post, so we could look out of the window and then up onto my sister's step. Resting places very, very important, for probably warm.
Snuggly, but they're not going to catch the paws. If you've got in Charlie's place, they've got a dog and little children, so this is a a way he can rest up high in the kitchen, and not, get under everybody's feet or get bowled over by children and the dog. So the deep, soft bedding, you can even get some which is heated, which is lovely.
I love this. This, this is, this is Bailey Ellis. Bailey was good at telling, his owner Sarah what he wanted.
So there are, the three cats cuddled up. But then Bailey goes, but Bailey had a really bad lung disease, and it just not the heat he wanted. So he took to sitting on the fireplace and eventually Sarah clocked it up, you want to fleece in front of the fireplace.
And at this point, you can see, Bailey's happy. There's my little Sheba. She claimed the duvet when we took it to bed, so we left it with her and used the other duvet, and here you can just see a simple box can be a good place to sleep.
When it comes to That must have a really safe hiding place. That is essential and it's a place that you mustn't pull them out of. So it's a good safe place under the bed, wherever.
And then it's whether or not you let them, out of the cat flat or not, remembering that with elderly cats, that's gonna. Lorry outside. Do you want them going outside?
Unsupervised when they're very elderly, maybe not. Toys are important, preferably not a very alive variety. You can get a range of toys which are nice and lightweight and easy for arthritic cats to play with.
And then this is one of these horizontal scratching posts. It's also got, pink on the wall inside it. So there's, mort playing with it and still have it.
And the new incumbents, McDuff loves this. He, he's only 2, but he loves to use the, the vertical scratching post along with the horizontal one. He likes to, like, he likes to use both.
I suppose it does his claws in different ways. I one is to file and one is to buff. I have no idea.
I mentioned outdoor access. If they're going out, then maybe supervised access is the best way unless you've got the set up that the lovely Catherine Martin, long gone now, has, so this is, this was her garden. It's one of the cats, summer.
And then you got steps up and then, there's a walkway all the way around and then safe, netting to go over the top. You haven't got that, so with Hoby, he's 26 in this picture, and Sarah Kaney would sit with him out on the, the, the stat, just for 5 minutes. It's all he wanted.
More would go out in the garden with me, on a lead or in the city. And then you can see other people have adapted things. This is a pen just in its design phase and obviously a whole lot more environmental enrichment.
So that's the environmental things. I know I spent a while on it, but I, I really felt it's important, . And you can distil that and put it into a really useful handout and it's good handouts from international cat care as well, remember.
What about food? Well, we've got a couple of diet studies here, one using Royal Cannon, and they used activity monitors, and this one using Hill's JD, both come out very, very well. And of course, we've got, combination diets.
So you've got things like JD with Kay. So if you've got a kidney cat that's also arthritic, so these combination diets can be a good way forward. And when you look at all the things that are in these diets, no wonder they can have a really significant improvement on these cats lifestyle.
What about condo protections on their own? I see that a lot of them are put into food. Well, data is coming, but it is, it's sort of limited.
We've got, well, it is limited, but there are some good bits, put it that way. Felicin, where's? Oh, it's the one directly across.
So, it showed this green lip muscle, and for me, if it hasn't got green lip muscle in it, I don't expect it to work. My go to diets, you move for cats. I've had some very nice outcomes with that.
I haven't done a proper style on it, but I anecdotally, anecdotally, I've had some lovely outcomes. And, and in this one where it's got green lip muscle plus. Coumarin, which of course anti-inflammatory, like currently for increased ability to grow, increased activity and playfulness, and an ability to go up the stairs.
That's pretty good, isn't it? And then the, and it, I can't say antino, this one is supposed to be a better extraction system for the green lip muscles. And then even omega 3s, in this study, reduced stiffness and more interaction with the owner and ability to jump higher.
So, even just omega 3s can have a, you know, they can have a beneficial effect, but it's a significant improvement. So, you know, they, but they're never gonna be able to really have a massive difference. These are for the early cases.
And remember, early cases can be as early as a year, and then had a knock with a car, something like that. And then what about NSAIDs? For years, people went, oh, you can't use NSAIDs, particularly if you're in the states, or, then a black box, it literally would draw a black box around it because you can't give NSAIDs, to cats, and it's just crazy, just about those.
And it means that lots of cats have not had analgesia when they really, really should have done. And so in a number of studies, What's been shown is that when you compare the cats with arthritis and kidney disease that get meloxicam, that's what these studies were about. To the cats with arthritis and kidney disease that don't get, meloxicam, it's a significant improvement in the quality of life and means survival time if they're given it.
Not surprising, is it? If they're painful, then the owners are going to say they've not got a good quality of life and they're more likely to euthanize them. The important thing is the dose.
Normal dose would be 0.05. Here we're talking about 0.02.
And one thing to note. There was an increase in UPC in some of these cats. So it is important when you start a cat on the account that you check the UPC.
If it is coming above 0.2. Then meloxicam is not for this cat, right?
So if it goes above 0.2, which is what we're aiming for with the cat with kidney disease. And I haven't seen as much data, on your, and of course, it's about length of licence.
The important thing with, NSAIDs is you titrate down. You don't start with a high dose. You start on this low dose and go even lower.
And take real care if they're prone to dehydration. So as I said, chronic kidney disease, hyperthyroidism, diabetes, all of those things I'm happy to use meloxicam for. Heart failure, if they're in congestive failure, I'm not gonna go there.
The GI disease, liver disease, or if they're on systemic corticosteroids, I'm not gonna go there. So I put the list in so I can say what I will and what won't go to. And the important thing is no food, no drugs.
So they've got to be fed first, if they don't take their food, they're not allowed the drug. What about other things? Well, we've got gabapentin and obviously, Gabba is our friend.
We're all very, very comfortable using it. What I would say is start with, a low dose. If they're very arthritic, you don't want them to fall while they're wobbly.
Amantadine, I used to have real trouble with because we only had human products which are really, really bitter. It's come up on the screen. I don't know if you can see this.
I'm just going to say dismiss. And hopefully that didn't cause you any concern. So amantadine summit now do, an amantadine.
And the advantage of amantadine and ketamine is they're gonna, they're gonna stop central windup, which is really important. Now, ketamine, you can use this very, very odd, very, very low sub kudos. It's a bit strange, but it does seem to work, anecdotally at least.
I know quite a few people who have done it who are using it, and it can last up to a month, just a little tiny dose, but anything from I say a week to a month. Tramadol, I'm not very keen on in cats doesn't always work. The opiates, Boop.
I do use, I'll just use a plate, a flat plate and put a little smear of something they really like Nicky licks typically, and then drip boop on top. And then they've got to lick the, the, the smear of the licky licks off. And by the time they've licked it all the way around and then it's actually taken in through the mouth.
So you don't have to faff around actually pushing it into the mouth. I haven't got on well with fentanyl patches. I'm not good at keeping them on cats, and they don't usually need meth but for this sort of disease.
What about, to that, Calencia, absolutely using bucket loads of it. Very, very pleased with it. I have seen one cat, that's this one, with itchy bald patches, which was, has been reported, by a number, on a number of occasions.
It's not considered a particularly rare side effect. So if you see that, then you need to Stop. But the thing that's throw in here while we're thinking about it is, yes, Calencia has got its licence for treatment of osteoarthritis, but it's just a painkiller.
It's a very funky painkiller, but it is just a painkiller. It's also been shown to be very good for pancreatic pain, so visceral pain. I find it to be very, very useful with dental pain as well.
So don't think of this as, as only for the joints. Think of this as a really good chronic painkiller, and that will really add to your armoury. And then, Galyrant has two lovely papers of it working very well in cats, but as yet, it's not available to us.
But if you've got through everything else, on this cat and cascading through, then yes, you can, you can get to the gallow print. And then what else could we try? Well, obesity movement, we've already talked about, etc.
Physiotherapy, absolutely. You know, I'm a great believer in physiotherapy. I have a, a lot of mobility issues myself and really, really help.
And owners can be trained to do it. There's me, massaging, basically doing physio on more like. We've got a hydrotherapy, got a picture up there.
I can't believe there are many gaps you would be convinced that this was actually good on a cost-benefit ratio. But what about acupuncture? Absolutely.
These are two cats having acupuncture. I hear that's Sam Lindley, which is, 10 acupuncture. But if you can see the little needles, in this little last one of my cases with a lot of both of these cases of mine actually cuts with a lot of paraspinal pain.
What did I think I've missed off. Oh, the, the ultrasound and laser therapy, nothing published, but anecdotally, there are certainly quite a few cats that it seems to make a, a very profound difference. Stem cell therapy, well, if there is inflammation, all the stem cells do is go to the inflamed place.
So then, yes, you don't need to inject it into each joint. You just get IV. It could be something to be considered.
If anyone wants to know recipes and things, come back to me. You can rise up the, the, the cells from 2 grammes of subcutaneous fat, and my best do that for you. Or you could use radiation if you happen to have a linear accelerator in your pocket.
And that could be if you've got one joint, for example, that's really sore joint, then, palliative, yeah. And surgery, it really is the salvage procedures of the ban removal of carts. I know, I love that picture.
Everything keeps coming up. I should have, I know, I know, I should have turned off my. Like to remind you.
This is Sally. She's a 16 year old Mogi. She's got a weight loss, she's arthritic, she's urinating outside the box.
She's skinny, we've got arthritis, we've got a few things going on. So we need to, to put all of those into play. When we look at her bloods.
Oh, kidney's not looking great, are they? Because she's a bit dehydrated and yet her USG is 10:35. She eats a combination of wet and dry food, so you should expect her USG, to be at least above 10:45, really.
She's on wet and dry food. But she's also a bit dehydrated and the urea and crackle, so her kidneys aren't fabulous. .
That's thyroid, 60, you could say, Oh, that's OK. You know, go to 65. But you and I know that now.
She's a sick cat. Look at her. She should not have people shouldn't be anything like normal.
It should be subnormal. A little old cat, it's got everything going on, sick as she is. Yeah.
If it was anything above 20, I'd be saying, I think she's hyperthyroid. So on that T4 of 60, I'm saying. Certain she's really hyperthyroid.
And that would certainly explain the raised ALT and AP, etc. Obviously, she's a bit stressed. So let's keep, but of course it could be primary liver disease that we're dealing with.
Yeah, absolutely it could be. That's my beautiful boy at the end of his life. And, and like morebi, and multiple interacting diseases and particularly if you've got all of the diseases that cause PUPD, so kidneys, diabetes, and hyperthyroidism, along with, arthritis, that's a problem because you're gonna have urination around the house just like our little case is doing.
And then if you've got Yeah, and actually all of those are gonna lead to dehydration, that's gonna make constipation worse. And if you've got arthritis, your constipation is gonna get even worse. So therefore, when you poop, you poop outside the box, which thankfully Sally's not doing.
And obviously, dementia, hypertension, hyperthyroidism, all of those can really play into each other much. So we investigate elderly cats, prompt and full investigation, we need to come over as though we really want people to bring in their elderly cats. We have to acknowledge that we know it's hard for them to bring the cats in.
You know, our website, etc. Needs to talk about, well, look, you know, we've got drugs like gabapentine and trazodone, they can really help, . Advice about how to get them acclimatised to a carrier, etc.
Also important, but get owners to monitor in our elderly cats. If you can convince them to get them to get their own cat scales. Once you've got them, you're gonna have them for every pet you ever gonna need.
Monitor for weight change, and then if there's been a weight loss of 5% or more, they know they need to come in. Yeah, harder to monitor for food and water consumption. Well, you can, you know, with how much water you're putting out, etc.
But certainly you're in faeces production unless they're still going outside, behavioural changes, and then, you know, a, a dementia, arthritis questionnaire, something like that, so the owners can, can read it and go. Yeah, I'm pretty certain my cat has got arthritis and or dementia. So I know I need to, to bring her into the clinic.
So we need to want self-motivation like that. But ultimately, we need to tailor them to the individual, because some cats like this old lad, it's not too bad, you know, he, he's now, I think, I haven't put his age on there. I think he's about 16 or 17 in that picture.
And he's still doing really well, you know, hybrid vigour, isn't it? He's a moor, whereas, yeah, my beautiful walk like 18 years, but for a Maine Coon. It's a Methuselah, as a fellow Maine Coon person told me.
So I think it's worth while me just underlining this a little bit, why owners don't want to bring elderly cats to the clinic. 5 reasons really. First, they think the changes are just normal ageing, weight loss, arthritis, a bit of confusion.
Then they get embarrassed that they can't cope, the fact that their cat has got increased vocalisation or is house soiling. For having the misconception that we wouldn't be able to help anyway. Then they start thinking, no, what, maybe I, I will bring my cat in, but then they worry about but she hates going to the clinic and she gets so stressed, etc.
Etc. And most importantly, they think we are going to recommend euthanize you. That is what came out of the study.
Repeatedly, owners worry that with an elderly cat, we're gonna say basically. Get rid of this one, get a kitten instead. So we need to really embrace looking after our our.
So the checklist that we talked about, getting them to do this at home, getting them to realise that it's something wrong, even getting them to send a video in so you can look at it and go, yep, absolutely, you need to come in. Get a body weight first, remembering more than 5% is bad. And if you tell owners that to start with, they'll then look at the scales at the same time as you, and if they're good at maths, they're gonna go, oh, you do want to do bloods, don't you?
Then I do an eye exam. Why do I do that? Well, some cats don't like you doing blood pressure.
Most cats, I can get at least a distant indirect ophthalmoscopy done, which is a version of what we see one of my students doing here, you know, where we're just looking to see what's happening at the back of the retina. Why is this so important? We must know what the blood pressure is, or at least that there's no ocular bleeding before we take bloods.
Always upsets me to talk about this. This was a cat called Charlie, little black cat. He's 15, I saw him when I was a resident.
Long, long time ago. I was very keen, despite the fact I just looked at his eyes and seen retinal bleeding. I'd just done his blood pressure and it was over 220.
I took blood. I'll try to. It was as good as gold.
My nurse just lifted his chin up, just raised his jugular, just a little needle in. He took a huge seizure and died. I killed Johnny.
OK. He did have hyperthyroidism, so we wouldn't have lived for very much longer, but hyperthyroidism, you, I could have got him maybe another 3 or 4 or 5 years. That was my being, me being stupid.
So please, please, please, with elderly cats, make sure that they are not hypertensive before you bleed them. And people then go, Oh, but if it would be OK if I took it from his leg, he's still got the stress of holding. Much better to give amlodipine and gabapentin.
Wait 20 minutes, minute, tea room somewhere, don't mind, get to sit in the car. Don't go out past the dog dogs, then take him home. Much, much better to do it that way.
And then these are, steps, designed for, for Adam Joli. Sorry about the colour. I had a bit of a brain fart when I said cats like purple, because they can't see red, so it's blue, what they're actually seeing.
And pictures and the video were taken by Sarah Kaney, and I wanted steps so that either I could put the cat on step and they would then walk down, or you open the basket and they would walk up. Some of those in the role, preferably both, and then this is, . Monitor screen showing fish for the cat.
Put the cat basket on here in front of the fish and that's a wonderful set. But yeah, I don't think the well that run out. Oh, yes, there you go.
There you go. Little girl going down the steps. Can see they've had to be reinforced a little.
Over the years, but you could see that she's got arthritic problems. So really, really useful thing if you've got space, then yes, put in some, some, some steps. What about Sally?
Well, we found her ECG. She's got a mom. I know this little cat.
Scruffy old mg, but as is almost always the case, say, from one of my previous studies, I can't remember if I mentioned it, in previous talk, when we asked owners of the elderly cats whether we asked them how much they still like their cat. 96% said they loved them as much or more than they did when they were younger. So owners don't want.
A cat. They want this cat, and Sally's owners were desperate. We do the very, very best for her.
So we did, an ECG. She's got two tall QRSs, thoracic radiographs boring. She's got moderate hypertrophic cardiomyopathy.
You see these tall QRS's here, abdo ultrasound boring, and then on her MRI, she has got some, some atrophy of her brain. So she does have some breath. So interpretation of finding.
Well, we've got increased urea and creatinine, specific gravity of 10:35 and slightly dehydrated. So I think we're all happy, yeah, she's got marginal kidney disease. I think I would take off the possible.
I think further amount from this case, she's got early hyperthyroidism. We could have checked that by, checking the, the, the TSH. Secondary hypertrophy or HCM.
It's unusual to have got secondary cardiac hypertrophy from hyperthyroidism, kidney disease, and you saw her blood pressure was, was OK, . Kidney disease and the hyperthyroidism not really enough to cause the cardiac changes in, in her, but at this stage it's more likely to be a secondary effect. She's still stress.
Dementia and arthritis. And the management, well, the dementia, we've already talked about, that's the environmental modification and of course, all of those things increase in the core core territory, the safety and security of the core, territory, making sure that you've got access to all key resources. It's the same whether it is for dementia or for arthritis.
So that's a win win win. And then diet. Of course, we've got, JD has been shown to have some positive effects and we've got those other diets as well.
We talked about supplementation and we did talk about potential drugs for dementia, but they always go further down the line. And for arthritis, so remember this cat's got both. All the environmental changes as above, make sure they're all on the same level or add steps, and I've mentioned I'm really not keen on RAMs.
Deep soft bedding, but make sure toenails can't get caught in it, shallow litter boxes or at least shallow on one side. You know, what some people do is they just put a big low litter box inside a big cardboard box and just cut a doorway because that means it keeps all the litter in place, and that's kind of an easy way of doing it. Don't forget about massage.
Most owners are very happy to massage their cat if you just tell them how. Diet, and for Sally, I did put her on to JD, and then certainly, JD with Katie would be a, a better approach. I hadn't come out at the time when I saw her.
There's nothing to do surgically. Gabbapentin, initially we went on a low dose of, of non-steroidals and things, you know, initially we did environment and we did food and that she was like a new cat. It was wonderful environment and food.
You wouldn't think you could change a cat's quality of life so much by getting the diet and the food right. You absolutely can. And it was only when things got worse that we then went, OK, let's try a low dose of meloxicam, for her arthritis.
We didn't have Calencia then. If I had had Salencia, I would have been going for Calencia. I've been very pleased with it, but remember it can cause those itchy ears.
And diagnosis and monitoring. Well, we need to monitor her cardiac changes, what is causing those because we're not quite sure where that's coming from. We need to monitor her kidney disease.
Early hyperthyroidism, monitor, serum TSH. Remember, that's the dog one. And then regularly reassess because things change in these elderly cats and sometimes some things more important other times other things are.
And sometimes you can end up With a lot of drugs. You must then prioritise them. So say this is the first one to give.
If you can give this one then give that one, really, really important. And, this is one of my, my students taking this little cat's blood. There, there's definitely one pair too many hands here.
But if you look at the primary hands, you've got this hand just gently holding the chin up, slightly tilt to the side, and one hand just across her sternum. Elderly cats don't usually bring their paws up to scratch. So, that's much more comfortable for her.
And particularly with arthritis, we need to be thinking about that whenever we're holding them. You know, whatever we're doing with them, think arthritis. Keep the position of their joints neutral, particularly with things when they're anaesthetized.
For example, when you do a dental, don't pull those, those four legs right back. That could really hurt shoulders. Always be thinking, actually pant them to hold the cat in a neutral position whenever they're anaesthetized because it's very easy to pull them into the wrong position.
And then the owners say, oh, that's terrible recovery, and it was the anaesthetic, it's not normally the anaesthetic. The pain was caused by putting them around. So I hope that was useful.
Probably tell, I'm quite passionate about treating these guys. There's so much we can do to make the quality of life so much better. So, I thought I'd finish by just showing you this little book that I did not get any, .
Funds or anything from this, not at all. It's just, I think it's a really good little book and for owners that are really bonded and want to do as much as they can, this is a good one to go to. Thank you.