Hello, everyone. My name is Alex Taylor. I'm a registered veterinary nurse, and I work at the, as the Wellbeing and behaviour advisor at the charity International Cat Care.
Welcome to this session, where we're going to be talking all about the role of veterinary nurses in the prevention and management of felo and idiopathic cystitis. And I think the veterinary nurses have a really important role to play in this. You know, we know that FIC is a stress related disease and why certain aspects of this may be out of our control, we can certainly advise owners on how to optimise their cat's environment, to minimise any stress in the first place and help to improve their wellbeing, which is gonna prevent, hopefully prevent the condition from occurring in the first place, or at least help to prevent any further episodes of FIC.
So just very quickly, here's my conflict of interest slide, as I mentioned, I work for the cat charity International Cat Care, and there will be some resources throughout this lecture, so my cat care resources that I think that you'll find useful. OK, so just to give you an idea of what we're gonna be covering in this session, what's listed here is a kind of shortened version of your learning outcomes. So, first of all, we're going to look at the risk factors associated with the development of FYC.
So why some caps are predisposed to getting FYC or at higher risk of developing FIC. Then we're gonna cover the clinical and behavioural signs of cats affected by FYC. Now I'm sure you'll be familiar with some of these already, but I think it's worth us doing a recap, especially with with someone's behavioural signs that owners might be reporting to us.
Then we're gonna look at the comorbidities that present in cats with FIC and delve a bit deeper into the term Pandora's syndrome. You may have heard of that before. We're gonna take a look at the work of Doctor Tony Buffington, who's a vet that who's identified that cats with a PIC are also likely to present with diseases of other systems as well, not just the urinary system.
Then we're gonna cover the species specific needs of cats and why these are so important, and I think this is an often overlooked part of managing cats with FIC it's an area where veterinary nurses can have a really positive impact cos we can advise owners on how to optimise their cat's environment. Then we're gonna look at the veterinary nurse's role in the prevention and management of FIC so we're gonna look in a bit more detail at the sort of advice that we can give cat owners to help optimise that cat cat's environment in relation to their species specific, and, and their individual needs. And then lastly, we're gonna cover why referral to a veterinary or clinical animal behaviourist may be needed.
And I think that some cats will really benefit from this, but again, I think unfortunately this is sometimes overlooked or perhaps not even considered. But it can make a really big difference to that cat's quality of life and reduce the likelihood of premature euthanasia, which does sometimes happen with with some of these cases. OK, so let's have a look at what FIC is.
You know, do we even call it that anymore? Well, some, some veterinary professionals prefer to call it feline interstitial cystitis, because it's similar to humans that are affected by interstitial cystitis, or even stress cystitis, which I think is, is quite easy for owners to understand. And the the proper definition is that FIC is inflammation of the bladder with an unknown aetiology.
So we don't really know exactly why it happens, but we do understand a little bit more about FYC than we did sort of 20 or 30 years ago. But it is, it is still quite complicated, so, . FIC is the most common cause of feline lower urinary tract disease in young to middle aged cats, so about 2/3 of cats will with FLUTD will have FIC.
It occurs due to these kind of complex interactions between the nervous, endocrine and urinary urinary systems, so there's a kind of chronic activation of the sensual stress response in these cats, which involves these systems. As I mentioned before, it's called Pandora's syndrome, as it affects multiple organs, not just, not just the urinary system. So cats will often present with comorbidities, but, but there's, there's no specific cause, and flare-ups can occur because the cat is affected by chronic stress due to exposure to stressors in their environment.
It's also worth noting that FIC can be triggered by a stressful event, so some cats will develop it after an event such as the introduction of a new baby or a new dog or a cat in the home, . And, you know, sometimes this can be worse if they're exposed to several stressors all at all at sort of one after the other. So, what we call stresses stuck in.
So it could be a new cat's been introduced into the home, but also, maybe there's fireworks going on outside as well. And all these things can contribute to that cat stress, making it difficult to cope, within its home environment. It's also thought that some cats are predisposed to developing FIC.
There's a link with genetics and epigenetics as well, so there's the potential for a cat to be predisposed to developing FYC if family members been affected, such as their parents. But it can also occur due to epigenetic changes, so this is changes in the gene expression. Caused certainly by prenatal stress.
So if a pregnant queen is exposed to stress, then her kittens will be exposed to higher levels of stress hormones before birth and therefore they will have a lower threshold of arousal to specific stresses. So what that means is they're, they're more easily and quickly stressed by unaffected cats. OK, so the pathophysiology of FYC is quite unclear, but it's thought that these cats do have, a nervous, nervous system and hormonal abnormalities where essentially they have abnormal hormonal and sympathetic responses to stress.
So this means that they have an increased sympathetic nervous system activity. So the sympathetic nervous system we know is our fight or flight system that helps animals respond appropriately to danger, it, you know, it does play a role. But this is in in the activity here is increased in cats that have been affected by FIC.
These cats are also thought to have an increased startle response, so one study showed that cats with FYC have an exaggerated response to noise, unless, interestingly, they live in a highly enriched environment, which is why, you know, making sure their environment is species appropriate, is, is so important, and this is where veterinary nurses sort of come into play really. It's also been shown that these cats have an increased plasma levels of noradrenaline. So we know that noradrenaline is a transmitter of the brain, an important neurotransmitter, that plays an essential role in the regulation of stress reactions.
And this is linked with, with bladder issues, bladder issues in cats. They get this, kind of increased seed nerve fibre activity. And these are the nerve fibres that we associate with kind of aching, burning, delayed or kind of lingering pain.
Also, cats with FIC have been shown to have small adrenal glands and decreased levels of cortisol, compared to cats that aren't affected by FIC, so they have a kind of different or abnormal response to stress compared to unaffected cats. Unsurprisingly, cats with FIC have urinary system abnormalities, so. They'll have an increased permeability to the bladder wall, cause caused by damage to, and, and dysfunction to the protective glycosome and a glycan layer.
So the gag layer, you may have heard of it, referred to that before. And this kind of increased permeability means that, the, the urine, which is duly concentrated in these cats, penetrates the submucosa and causes pain, and so it stimulates the sensory neurons in the bladder. Making the bladder irritated and inflamed, you know, we know that cats aren't big drinkers, they don't have a big thirst drive, so their urine is more likely to be concentrated, so it's just gonna aggravate that bladder wall even more.
Now, you may not be surprised with some of the risk factors that we've got listed here on the slide. Let's go through some of these now, and what I think is quite interesting here is that a lot of these risk factors are kind of linked with each other as well. So we know that obesity, cats that are obese are at higher risk of, developing FIC.
This is because they're less active, and for some of them, if they're very obese, they may be less able to perform normal cat behaviours to help maintain their health, and to stay safe. OK, . We know that that cats with FIC are more likely to have a sedentary lifestyle, OK, and that therefore, they're gonna be more likely to be obese as well.
So again, they can't, they, they're less likely to engage in these normal cat behaviours. So these are things such as, play, or hunting or exploring, meaning that these cats are more likely to be, to be bored. Neuter cats, again, they're more likely to be less active and more prone to obesity, which puts them at a higher risk factor of developing I see.
And certainly cats that are indoor only, or they, those that don't have free access to the outside, so perhaps they don't have the control over when they go in and out, and are unable to get away from stressors inside the home, be that cats that they live with, or. Cats outside of the home that they can't chase away because they're stuck indoors, means that these cats are are much more likely to be kind of stressed and therefore and and obese. And board are more likely to develop FIC.
And certainly for some of these cats, they will only be able to use, their indoor litter facilities unless they've got, you know, something outdoors that's enclosed, maybe like a patio or something like that. So they don't have any choice or control over really where their toilet. So this means that, You know, they may be struggling to access their, their litter facilities, perhaps there's another cat blocking access or ambushing them when they come out of the tray, and of course this is gonna be quite stressful for them and not gonna encourage regular use of the litter tray.
Multi-cat households, we know this can be a real issue for cats, they're not very good at sharing, so we get a lot of competition over key resources such as food, but also importantly for these cats, their litter facilities and also resting facilities as well, so they're gonna be affected by this sort of social stress and much more likely to develop stress related illness. Poor train management management is. A really big issue for these cats.
So if their litter facilities aren't cleaned regularly, or perhaps they're not big enough or they're not in the right location, then these, again, this is gonna mean that these cats are at high risk of developing FIC. And I'm gonna go through a bit later on in this lecture, how to optimise a cat's litter facilities, because I think this is a really important part of of management. And then lastly, .
Reduced water intake can be an issue for these cats. So, yes, cats drink enough fluid to survive, of course they do. But if access to their water stations is challenged by other cats, or perhaps if they're fed a dry only diet, so they're not getting that extra moisture from their food, this is going to put them at higher risk of developing FIC.
Now it's not to say that the, the diet itself causes this problem, it's just the fact that they're not taking in this, that, that extra moisture. Excuse me. So really a lot of these risk factors are associated with the cat's needs not being met, and this can certainly trigger stress related disease.
OK, so if we have a look at some of the clinical signs, I wanted just to cover some of the terms that we tend to use quite commonly for, to describe the symptoms of of cats with FIC so. An owner may report to us that the cat is having lots of issues, either just passing the urine, or they're going backwards and forwards from the litter tray. But when we're making our clinical notes, we may use some of these terms.
So, let's have a bit of a recap. So, polyurea, this is excessive or frequent urination, so this is when we see cats going backwards and forwards from their list of tras they feel like they need to pass urine all the time. Dysurea.
This is a difficulty with urinating, which of course is quite common with these cats. Strangeangura is this kind of real intense straining to urinate and owners may report to us that the cat is spending longer in the litter tray than than normal. Hematuria, well, I think most of us know that that means blood in the urine and that's really common with with cats because they get such significant inflammation of their bladder.
And then perilurea as well. So this is where we see cats urinating outside of the tray. So essentially house soiling.
And I do, I do find with, a lot of these cats that they tend to sort of dribble patches of bloody urine around the home. They find it quite difficult to try and control, how they kind of urinate and, and where they urinate, if you like. I also, I also thought I'd mentioned that, the urine in with most, in most cats with FIC is tends to be sterile.
So there's not usually any need for antibiotics, and I know certainly as as veterinary nurses, we don't have any control over, medications that are prescribed. But you know, we do need to be really mindful of how often we're prescribing antibiotics at the moment because of problems with resistance. So it may be that we just need to remind the vet that OK, generally in most of these cases we, we don't need to prescribe antibiotics, there's no need to.
OK, so if we have a bit of a closer look at the clinical signs and we can sort of separate some of these into non-obstructive and obstructive FIC so. We know that male cats can with FYC can develop urethral spasms or urethral plugs, which I'm sure most of you know can be quite serious, but . A lot of the time, er, these cats are affected by non-obstructive, FIC and these these signs we may see in in male or female cats, of course, so.
Often with these cats they have quite a thick and painful bladder, which you may be able to feel if you gently palpate the cat's abdomen. And these these signs are self-limiting, so they, they tend to clear up within about sort of 5 to 10 days usually. And they may also wax and wane, so.
They may kind of improve and they get better and then improve, and I think this is why it's difficult for us to know how effective a treatment is, cause a lot of cats will just improve anyway, the symptoms will come and go, but they'll eventually they'll just improve and get better. Then if we look at obstructive FIC. Where we've got no urine output, no urine output, and this can be obviously very serious.
These cats tend to have a very thick, enlarged, sort of hard bladder, sorry, that's, that's very large and quite easy to palpate. And obviously, we're feeding cats where we suspect they may have a urethral blockage, if we're feeling their abdomen, palpating their abdomen, we just need to do that really carefully because there's potential for their bladder to rupture. What I found with quite a few of these cats is that they can have a bit of an unusual gait, they can almost look attaxic especially if they've been suffering from a urethral blockage for quite some time.
I've seen that before when a cat's come to the practise suspected of something like a pelvic injury and it's actually turned out that it's just got a urethral blockage and its bladder is so enlarged and it's so uncomfortable. And these cats can get really poorly, they can vomit. They may well collapse, often they'll be hyperkalemic, asotemic, and they may have cardiac arrhythmias and, and bradycardia as well.
So it can be very serious, it could be fatal for the cats and quite expensive for the owner to treat. So this is why it's so important for veterinary nurses to give advice about reducing stress and optimising that cat's environment, cos that's gonna help prevent any further incidences of FIC. So you can see on this slide I've got some behavioural signs that occur in in these cats now.
I think it's worth Noting that pretty much all of these behavioural signs are associated with pain or discomfort. OK, this is all because the cat feels really uncomfortable in, in their bladder area. So we may see cats that will repeatedly groom either their ventral caudal abdomen, and often they'll get some sort of alopecia there almost they'll they'll go kind of bald around that area, especially if they've had several, several episodes of FIC and that that that kind of almost continual discomfort.
Or they may groom around their genital areas, certainly because again they, they're painful around there when they urinate it's painful. As I mentioned before, we may see cats that are going forward from the litter tray again, but just because they're uncomfortable and they've this constant kind of need to urinate, or they could be house soiling because they're not making it to the tray in time. They can't control how easily they, how they, where they urinate, sorry.
And some of these cats will develop an aversion to their litter tray, because they'll have that association with pain. You know, they, they associate that, that litter trait in that area with discomfort, so therefore they just don't want to use it. We may also see cats that are excessively vocalising or becoming quite restless, so.
Owners will often report that the cat is vocalising when it's actually trying to urinate on its spot in their litter tray, which is quite sad when they do that. I, I've seen cats that, you know, when they're trying to use their tray and they're really vocalising because they're just so uncomfortable. Is may see that like you, oh, the cat seems a bit agitated or a bit restless, or even a bit kind of irritable as well.
So we may see these repulsion behaviours towards people, so this is just a cat essentially trying to protect itself cos it feels uncomfortable, so they may be kissing or growling or swiping or even trying to bite either people or other animals during interactions, so they're experiencing these kind of protective emotions such as . Fear or anxiety and, and pain as well, you know, we know pain is a sensory and an emotional experience, so they're really just behaving this way because they're trying to, keep themselves safe as as little survivalists, cos that's what they are as a species. Some cats will also just become really withdraw, withdrawn to for for the same reasons, you know, cats are self-sufficient survivalists and as a survival strategy if they're ill or in pain, they will often they will hide.
OK, so I mentioned earlier about a term called Pandora syndrome. And this is, based on the works of er of Doctor Tony Buffington, and he's done, he's a vet that's done a lot of research into cats with FLUTD and he's shown really that cats with FIC are more likely to be affected by other disorders too. And you can see there's a long list here on the slide.
it, this is called Pandora's syndrome because we don't really know the specific cause of these health issues, but they do go beyond the bladder. And it's thought, thought that cats with FIC. Have these other, and these other comorbidities, just because it's just triggered by sort of chronic stress, exposure to chronic stress.
It's also worth noting that these comorbidities may be present before the FIC develops as well, so it's not necessarily at the same time or after it could happen beforehand too. OK, so let's take a closer look at cats as a species. I've sort of touched on that a little bit already.
I think this will help us understand why cats behave the way they do, and why they are sometimes affected by stress-related illnesses such as FIC. So, domestic cats have, both species specific and individual needs. So, just like their wildcat ancestors, our pet cats are still programmed as little solitary survivalists.
And they are prey animals as well as predators, OK, so we know they're predators, but they are also prey animals too. And over time cats have developed to be socially flexible, but this can very much depend on the, on the individual. And in individual cats needs can be affected by their temperament, how well socialised they were during the sensitive period when their kitten.
Any ongoing experiences and the environment that they kind of live in now. And challenges to their resources, which are very important for cats, because they are these little solitary survivalists, can cause a lot of distress. And it's very much about choice and control with cats.
They like to have choice and they like to feel in control of their environment and kind of what's going on around them. And a lack of control in a, in an unsuitable environment or what we call a provocative environment can cause a lot of stress and therefore cats can develop stress-related illnesses such as FIC. So when we think about the cat's environment, we can, we can split this into two different sections.
You've got our physical environment, which is the kind of surroundings, anything that generally isn't another cat or an animal, including humans. So we're talking about inanimate objects, furniture, infrastructures, surfaces within that cat's kind of territory within their home. And then we've got the social environment as well, so this includes other cats, people, and and other animals such as dogs, for instance.
So when we think about the environmental needs of cats, we need to advise owners on how to meet their cats' needs in both types of environment. And if they, when their needs aren't met, this is when we can get behaviour problems and, and stress related illness. So here I have added a slide with an infographic from the AAFP and ISFM 2013 environmental needs guidelines.
You can see I've put a QR code on there that will take you towards this article, which I would highly recommend that you read. So I'm gonna give it to you as a bit of homework. It's an incredibly useful document for getting me nurses, it provides.
Lots of information about a cat species specific needs, and we can use these to advise owners to do have a read of those. Now, you can see, there's an infographic there with what we call the five pillars of a healthy feline environment, and these have been taken from those guidelines. And I think these are especially key when it comes to understanding cats' needs, and they're particularly, I mean, they're relevant for all cats, but they're particularly relevant for cats with FIC.
So, addressing a cat's needs is important because it can help prevent unwanted behaviours. It can highlight any health problems such as arthritis, FYC. You can certainly strengthen the bond between a cat and their owner if we're giving them advice on how to interact with their cat.
And certainly help to minimise conflict in multi households. And from our point of view, in clinical practise, it can actually help enable more effective veterinary care. So, some of, some of what's listed on the infographic here, some of these pillars are likely more applicable to a home environment, but some of them are applicable to a clinic environment too.
So do have a look at those if you can. OK, so let's take a look at how certain social environmental stresses can have a a negative impact on cats and trigger problems such as FYC. So, I've sort of put some pictures here on the slide and we'll work through those now.
So, inappropriate interactions with people can be a real problem, especially a lot of the time people don't realise that the way that they're interacting with their cat is unwanted, it's not how the cat would prefer to interact. So as people we tend to a lot, a lot of the time. When we see each other, we might give each other a hug or a kiss, or, you know, and we, we can be quite noisy, it can be quite high in intensity kind of interactions.
And cats don't really like that. They don't like being interacted with that way. Cats prefer low intensity, predictable interactions, and it always has to be on their terms.
And sometimes owners will say, oh, that their cat, Enjoys being picked up and cuddled and and kissed, but I think a lot of the time it's just that the cat's tolerating that, it doesn't necessarily mean that they enjoy it and, and that can certainly be an issue for them and contribute towards any stress they might be experiencing. Conflict in a multi-cat household is a big issue for a lot of cats. Social stress is usually over access to resources, especially food and litter trays and resting areas.
So this can definitely be an issue, as can dogs now, you know, dogs and cats can have really good relationships, especially if they're introduced in a. A controlled and, and staged and sort of a staged way so that the cat doesn't get stressed during that interaction, interaction, sorry. But if access to resources is prevented by the dog, maybe there's a lively puppy, that's kind of running around and the cat can't access somewhere safe to rest, or it can't, can't access their food, this is gonna undoubtedly cause quite a lot of stress.
Unfamiliar people in the home, that can be a problem. So if people that are, don't usually live inside the home, so I don't know, family members visiting, friends visiting, babies coming into the home, or children, this can be a source of stress for cats too, because they're obviously not familiar with those people, as can interloper cats coming into the, the garden or even into the house through the cat flat. Especially if they're trying to access that cat's food, but even just the cats staring in through, say some patio doors, a cat inside the home, can be stressful for the cat that's inside the home.
So, you know, neighbouring cats can be an issue too. I did want to briefly mention owner stress as well, because cats can pick up on our emotions, and they can, pick up on sort of how we're feeling. They're quite sensitive.
So if an owner's going through a lot of stress or there's a lot of conflict in the household between the people living there, then, that can be a source of stress for the cat too, as can the arrival of a new cat or another animal. This can be really challenging for cats who went, you know, we know that they're quite territorial. And if that introduction again isn't done in a nice slow and staged and and positive way, or if there's a mismatch between the cats, so maybe there's a, a little kitten that's been introduced to an adult cat that's less painful, and that can be quite stressful for the cats.
And then lastly, any changes in that cat's routine. So this could be, maybe the cat's being fed at different times or the owner's spending less or more time at home. This can be an additional stressor too.
So, these are, there's quite a lot of different types of social environmental stressors that we do need to consider when we're advising owners. There's lots of physical environmental stressors too. You can see I've got a few different pictures there on the slides.
So certainly weather can be an issue. And I think that's something we sometimes don't think about, in that picture there on the slide, that's my two cats, and, and they weren't too keen on going out in the snow. And I think that's, true for a lot of cats as well.
You know, they don't necessarily like snow or a lot of rain, or even if it's really windy outside. They don't want to go outside, they might be forced to spend more time inside the home, with cats and it might be, with cats that they live with, and these could be cats that they don't get along with, or other animals, such as, you know, lively dogs or puppies, or even people that are not respecting their, their space within the home. So, you know, giving cats the opportunity to go outside, gives them that.
That means that they can get away from anything inside the home that, that they're finding stressful and obviously if they can't do that, then they're kind of stuck really. Fireworks, you know, we know fireworks can be stressful for most animals, and nowadays they can go on for, for weeks. And this is gonna mean that the cat is exposed to this stressor for a long period of time.
And again, they may not want to venture outside, so they're spending more time indoors and, and can't get away from other animals or people, you know, they can't get the space that they need. Po trade management. Definitely a, a, a big issue for these cats.
We're gonna go through management a bit later, but it's it can be a particular problem for cats living in a multi-cat household. And they don't like to share facilities and they don't like to use soil trays as well, so if the owner's not keeping on top of that, that can be a real issue. And then I've also put travelling there, especially to the vets.
We know, we know a lot of cats don't like travelling, which is why carrier training is, is so important. But if that cat has chronic health condition or an injury. And they need frequent visits to the vets, they're gonna be exposed to lots of lots of stressors, you know, in the car, during travel, and also when they arrive at the clinic as well.
So again this could be another trigger, FIC. And then moving home as well, so, you know, as I mentioned before, cats are programmed as little, little survivalists, and they're quite territorial, so moving home can bring its own additional stressors. Because the whole physical environment is new and it's changed and there may be things like unfamiliar cats in the garden in their new home that, you know, they, they don't know them and some conflict may occur and that could be an additional source of stress.
And then lastly I've just put building work on there as well because. I think sometimes we forget about that, but building work can go on for weeks or even months. There's gonna be unfamiliar people in the home, lots of noise, lots of dust and and strange smells, etc.
Etc. So building work can certainly trigger stress in in cats, we know that. OK, so let's have a look, have a look at the role of veterinary nurses because I think it's vital, it's really important.
And we'll start by looking at triage that we may give over the phone or on arrival at at the clinic, so. What can you do now? What can you ask the owner now?
Well, certainly we need to make sure that we get history. So if an owner phones up and they're worried about their cat saying it's having problems urinating, we need to ask a few more questions, because obviously, you know, there may be an emergency there. So can the cat urinate?
Are they straining to urinate? Can they pass any urine at all? How frequently is the cat visiting their litter tray?
And we can also check on the cat's history and see, have they had any episodes of cystitis before. And also see if any previous treatment or behavioural advice has been given before as well. But when we see the cat in the consult room, of course we're gonna do a sort of usual checks, so we'll do a temperature, pulse and respiration, give the cat a sort of a general examination.
But I think we should also make sure we do a pain assessment. It should be part of our examination process, so we don't want to forget to pain score. I quite like using the feline grimace scale, .
As a, as a way of measuring pain in cats, you can just see I've put a QR code on the slide here that will take you to the feline grooming scale website, but it also is available in an app too, which is really handy. So it means owners can can use it at home too. I also like feel like grey scale because it means that you don't actually have to touch the, the cat when you make that assessment.
So we do, we do still want to ask questions about how the cat's been overall and any other behavioural signs, that may, may have indicated pain at home. And also when we're assessing the cat, when it's on our examination table. So perhaps the cat's got like a hunched body posture, or they seem quite restless, or they're sort of over grooming around their genital area.
These are all signs that the cat may be in pain. Now, what you could also do is to gently palpate, the cat's bladder if you feel confident enough to do so. But remember, just be really careful when you do this.
If you're not sure, or you don't feel confident, then I would wait for the vet to, to check, to check that. But, if you can do that, just do it really carefully, and then you can report the bladder size and how that bladder feels back to the vet. Then we're gonna refer on to the vet, and they can make a full assessment and give that cat any treatments, and then we can also offer a follow-up behaviour consult.
Now, I think when we do this, we need to do it once the cat is feeling better and recovered. So, what you might want to do is when the cat's had, some treatment and then it's been sent home, you could phone the owner a few days later to see how the cat's getting on, and then also book, a proposed kind of behavioural appointment with them. And the reason I say this is because I think the owner's less likely to be stressed, and take on any advice that you give if you do it, you know, outside of the, the window when the cat's, actually feeling poorly, and then you can have a proper chat about how the cat's, how you're gonna manage that cat and, sort of work with the owner.
To do that. So, what can you do I ask in a follow up behaviour consult? Well, certainly, we're gonna ask about, if there's been any changes, to that cat's routine or their environment, you know, what's changed?
Are there any new people or animals, in the home? Is there any building work going on? Remember what I said about all the social, stressors and, and the, the physical and environmental stresses.
We need to make sure we cover all of those. Have we seen any changes in the cat's behaviour? What, what has the owner observed?
Does the cat seem more withdrawn, or less interactive or playful? Have there been any changes in the cat's appetite? Or is the cat, you know, has the cat's behaviour changed to the point where it doesn't want any interactions, maybe it's hiding, or it's, the owner's reporting that the cat seems irritable or, or grumpy when they try and, stroke, stroke them or pick them up?
And then what we can do is use questionnaires. To or ask questions and gather information and also perform what I call a stressor audit, which I'm gonna go through on this next slide. So a stressor, if we think about what a stressor is, is, is an experience, event or stimulus that the cat perceives negatively or finds unpleasant.
So stressor audits can be used to identify how these stressors are impacting negatively on that individual cat's welfare. So we're gonna consider the physical and social social stresses in the cat's environment. Don't forget to consider also the cat's physical health too, so not just the fact that the cats had FIC but any other illnesses that they might be affected by because illness itself can be a stressor.
Then we can, you can consider the frequency, intensity and duration of each stressor. So what I mean by that is how often, how severe, and how long has the cat been subjected to that stressor. So, for instance, if there's, a new cat in the home, and perhaps some conflict has been occurring, how often is this happening?
Is it every week? Is it every few days? Is it every day?
You know, how, how bad is that conflict when it happens? Is it just that the cat's being stared at? And their resources are being blocked or is there actually some chasing or physical fighting going on?
So how long does the conflict go on for, you know, is it just a couple of minutes, half an hour, or does it seem to be happening pretty much continually? So these are all questions that we can ask, owners, when we're performing our stressor audit. And we also need to consider the individual themselves, you know, what sort of temperament do they have?
Has the owner described to you that the cat seems to be, quite nervous, it has quite an anxious disposition, you know, how do they cope to any changes in their environment? And it's useful to know this because if the owner says to you that the cat seems quite anxious at home, then they may well be one of these cats that's kind of predisposed to, to stress and, and stress related illnesses. It's also important to complete any questionnaires and or the audit before you advise the owner as well.
So just make sure you've done it first, and then you can consider what the results are, come up with a plan, and then provide any follow up support, be that, written, a written report, a phone call, maybe both. And don't forget to record any conversations and, save any sort of additional, documents on that cat's records as well, so that you can go back to them. In the future if you need to.
OK, so you may have heard of the term memo before. This stands for multimodal environmental modification. So this was a term coined by Doctor Tony Babbleton.
I, I think really, this quote from him just highlights what we really need to be thinking about when we're managing cats with FIC. So you can see here it says that the goal of multimodal environmental modification is to create and sustain an environment where a cat's perception or control is re reliably greater than their perception of threat. So what this means is the cat needs to feel safe in their environment.
OK, and if they feel safe, this means that they're gonna be much less likely to to develop stress related illness. OK, so let's go through the different resources and how we can best advise owners about how to optimise the cat's environment and optimise those resources. So we'll start by taking a look at resting areas.
So it's really important that we provide a safe place for cats. It gives them the opportunity to retreat and relax somewhere where they feel safe and where they can have some privacy and some protection. Remember I mentioned about cats being prey animals as well as predators, so they do need to be, they do need to feel safe, for their sort of welfare to not be compromised.
So ideally we need to offer raised and sort of hidden concealed resting areas. Cats feel safe when they're up high, so having at least a selection of resting areas, can be really useful for cats, if they're elevated, and they can kind of observe their environment from a place of safety, and they're much less likely to be disturbed as well. Having said that, it can be useful to put some at floor level, especially if they're well hidden, like under a bed or something like that, or a box, that's sort of well hidden somewhere.
Bear in mind that in a multi-cat households, some of these beds need to have a multiple exit or entry points or large exit and entry points, just so that cats aren't blocking each other from going in and out of their resting area. And access needs to be nice and easy. So, FYC tends to affect.
Younger cats, but they may have mobility issues, say if you have, I don't know, three-legged cats, something like that. We need to make sure that access to resting areas is, is easy, so it may be that the owner has to put some steps in or some additional furniture so the cat can access that place of safety. We also need to make sure that we offer a sufficient number of resting areas within the home.
So the general rule is one per cat and a spare. And as I put on the slide, you know, you can never have too many resting areas. And I just wanted to briefly mention that these resting areas need to be big enough for the cat to properly, properly relax, and almost stretch out a little bit as well.
You know, some of these, cat trees that you can get, they have quite small beds, and they're more sort of perching areas than resting areas, really. So, resting areas are important in all households, but they're particularly important in multi-cat households. OK, so we need to make sure we offer those safe places.
And they don't have to be fancy, you know, yes, you can get lovely cat trees and beds, but they can be cardboard boxes or human furniture, you know, all of these things, can be useful for cats and help them feel safe in their home environment. OK, so litter facilities is really, really important for all cats, but it's crucial for cats with FYC. It's crucial that we offer optimum litter facilities.
So litter tray size is really important because a lot of litter trays that are sold in shops are too small for cats. And experts do recommend that litter trays should be approximately 1.5 times the length of the cat from their nose to the base of their tail, which is quite long, it's quite big.
Now you can see in the photo on this slide, I've got, a litter tray here. And this isn't actually a litter tray, it's a storage box, it's one of those sort of under the bed storage containers, it's quite shallow, but it's quite big, so they, they make nice litter trays. It's important that we offer, offer a sufficient number of litter trays.
So, again, it's a minimum of one per cat plus a spare. Because cats need to be able to access their litter facilities without worrying about another cat trying to jump on them when they, come out of that litter tray or even blocking them from accessing that litter tray as well. Location is important, they must not be in busy areas, they need to be away from resources, such as food and other litter trays, but, it needs to be somewhere that's nice and quiet cos cats are quite sort of vulnerable, they feel quite vulnerable when they toilet, so somewhere nice and quiet is best, really.
When it comes to litter choice, cats will have their own preference. But most cat like cats like soft sand like litters, and this is because their ancestors are kind of desert dwelling cats. And the softer, finer litter is easier for cats to dig and rake, which a lot of cats like to do.
And you can try talking to owners about maybe using a clumping litter as well, which is nice and easy for owners to remove, so it keeps the tray a bit cleaner as well. Just be mindful, if they do decide to change the litter, then they need to do that slowly. So, what I would recommend doing is offering the, a, a litter tray with the old littering and then one with the new litter in as well.
I think, sort of, just seeing if the cat starts to use the new litter and see if they prefer that. Because if we do a sudden change, that can be a stressor as well. There's lots of different types of litter trays you can get, so you can get covered or hooded litter trays, uncovered or self-cleaning.
Now again, cats will have their own preference, but hooded trays can often be a little bit small and restrict movement, and they do hold in the smell of urine or faeces. Which is great for us, but not so great for the cats. So we need to consider removing, removing the cat flap, not the cat flap, the flap on the tray, if we do offer a hooded tray, and just talking to owners about making sure that they don't forget to clean that tray regularly.
I don't tend to advise the self cleaning trays, I think they're usually too small and they're quite noisy, so I don't think they're gonna encourage use and they are quite expensive as well. When it comes to hygiene and cleaning, we can talk to owners about . Regular cleaning of the tray, they can follow, a sort of a good protocol.
So that means cleaning that tray out twice a day, at minimum, at least, and a complete clean every sort of 1 to 2 weeks. We know that cats don't like using soiled trays, so cleaning them regularly is really important, especially for cats with FIC. And if you take a look here on the QR code on this slide, this will take you to, the AFP and IFM guidelines for diagnosing and solving house soiling behaviour in cats.
Appreciate that as nurses, we're not gonna be, diagnosing, but there's some really good tips on literary hygiene in there if you wanted to take a look. I would recommend avoiding any scented products or any scented litters, because cats have a very sensitive sense of smell, so they don't like strong perfumes or odours, they find them unpleasant and just don't. Don't use tray liners and don't recommend the use of tray liners cos they can get stuck in cat's claws and it can actually frighten them when they use their tray cos they scrape and get it stuck in their claw, that can be, that can be unpleasant for them.
And we can also talk about offering an outdoor toileting area as another option. I've done this in my own garden with my cats, just put some san down sand down. In a sort of flower bed area and make sure there's some nice coverage there and this helps cats to feel safe when they're using that litter facility, but also just give them another option for toileting.
OK, so let's move on to What we can do to increase the cat's water intake. This is really important because it helps to dilute, the urine. So we're really looking for, urine specific gravity of 1.035 with these cats.
We know that if the urine is more dilute, it's less likely to irritate the bladder. So, cats really like choice when it comes to any of their resources, really, but with water, definitely. And they will have their own preferences.
But there's a few things that we can advise owners. So, we can make sure that, there's enough water water stations within the home. So again, one plus a spare per cat, and make sure that each water station has easy access.
So, what I mean by this is. Making sure that the, water bowl or whatever it is they, they're using is away from the wall so that the cat has 360 degree access to that water bowl. And this means they won't have their back to the room when they're drinking, because they can feel a bit vulnerable, if, if that's the case, and then they're less likely to drink.
And we want to make sure that there's water stations on each level of the home. Now, most cats prefer to drink from a ceramic, glass or bowl, but some prefer running water, like taps or fountains. But I do advise not, not recommending small bowls.
Cats don't want their whiskers to touch the side when they drink, or when they eat as well. Having said that, some cats will have their own preference, and, you know, I used to have a cat that likes drinking out of a glass of water, so it can depend on the individual. We want to make sure that that water bowl is filled to the top.
Excuse me. Again, just so the cat. Doesn't have to dip their head down too low when they're drinking, because again, that can make them feel vulnerable.
We want to advise keeping any water away from food as well, cause cats prefer to eat and drink in separate areas. Excuse me. Mainly because they don't like their food to contaminate their water.
So you can see here on the slide, I've got a QR code. This is to the new, International cat care caregiver guides, and there's one here on increasing water intake. So it'll go into a bit more detail than I have in this, in this lecture, but it's also a really useful document for owners as well.
The cat has, any condition that means that they would benefit from drinking more water, you can give them that document, and there's some really useful tips in there. OK, so access to food, is really important. We wanna make sure, and I'm sure most people know this, but I'll, I'll recap on it anyway.
We're not gonna give that cat a new type of food until they're well, OK? Because we know that if the cat's not well, and if it feels nauseous or it's in pain, they, they're gonna be much less likely to eat a new food, and they could get even get an aversion to that food, so. We don't want to change the diet until the cat's feeling well, and just bear in mind that changing the diet itself can be a stressor for a cat.
So any, any, any time that we want to change the diet, we just need to make sure that we do it really gradually as well. Again, we're gonna make sure that access is easy, so keep, keep the food, away from any walls. Or even you could try talking to owners about putting the food bowl on a raised surface.
So you can see here, this is my cat, and he's actually, eating some food from the sort of bottom level of his cat tree. And he likes that because he feels safe, because he's, sort of up high. I would recommend avoiding using plastic bowls because they tend to harbour bacteria because they can be quite easily strapped scratched, and they can get tainted with the smell of whatever food's been in them before, and not offering double bowls just to get.
There's a whisker fatigue that cats can get where their whiskers touch the side, and it can be quite uncomfortable for them. The double holes tend to be quite small. So instead, we can try, nice flat ceramic, glass, or even the bamboo holes, which I've got here, in the photo here.
They're nice and flat. So nice and easy for the cat to, to, access their food. And yes, we need to change, change the diet gradually.
And usually with cats, I tend to. Recommend a 7 to 14 days, which seems like a long time, to change the food over, but cats can be quite neophobic. They don't always like new food.
So if you have a cat that's particularly picky, it can be useful to just change the diet really, really gradually and talk to owners about how they can do that. I'd also avoid giving medication in any main meals, because, again, the cat may not want to eat their, their diet then, we can try using treats instead. And really importantly, just making sure that the cat is fed away from any stressors, so other cats.
So we should be talking to owners about feeding their cats, in an area where they can't see, another cat, so a different room, ideally. And that's gonna make them feel less stressed when they're trying to access their food, which is a really important resource. I've just got a slide here on scratching facilities, which I'm not gonna go into too much detail now, but, I have written an article on, on scratching, and how to encourage cats to use scratching surfaces.
You know, scratching is really important for all cats, they need it to maintain their claw health, but also for things like climbing and hunting and defending themselves, but scratching is a form of communication as well, so. When we're advising owners about scratching surfaces, again, we want to ask them to offer multiple scratching stations or, or areas within the home, you know, giving cats options over where they'd like to scratch. And generally, cats will scratch either near, or they like to scratch near where they wake up.
They've been sleeping, they like to have a stretch and then a scratch, or on the edge of their territory. If you want any more tips on this, just, if you're already an IFM nurse. Have an IFM nurse membership, which is free.
You should be able to access this feline Focus article which I wrote this year. If you need some advice on how to access feline focus generally, you can just, have a look at that QR code, which, it takes you to a YouTube video, which will show you how you can do that. And I'll that's explained in a bit more detail.
OK, so, play is really important for all cats, not just kittens, but it can be a really useful tool for, for helping to sort of reduce stress and anxiety in cats. It can help to, maintain cognitive health in older cats as well, but it does give cats mental and physical stimulation. And because it kind of mimics that predatory hunting sequence in cats.
So it's, it's necessary for all, all cats, but. When you're talking to owners about playtime, I would always advise offering solitary playtime in multi-cat households because cats are solitary hunters and they're solitary feeders. So just like with the feeding, we need to make sure that we offer solitary play sessions as well.
OK, and you can see there's another QR code on there with some really good resources for play, from the International Cat Care website if you wanted to take a look at that. But, you know, play. It's not gonna solve a stress related illness, but it's just another thing to have in your toolbox to help reduce sort of anxiety and just provide that extra bit of stimulation for the cat, and it can just really enhance the bond between the cat and their owner too.
I did want to mention about interactions, human interactions, as I mentioned before, perhaps prefer predictable, consistent and low tensity interactions. So it's important that caregivers are advised that, you know, actually Fluffy might not like being picked up and kissed and cuddled, but there's lots of ways you can interact with your cat that that will be on your cat's terms. And you can see, there's a diagram here on the left hand side of this slide.
This is based on the works of Doctor Laureninca and Doctor Sarah Ellis, and it just shows the areas where cats, prefer to be touched or where they perhaps don't like to be touched. Now, this, again, may depend on the individual, but it can be a really useful tool, and I think it's quite, a useful picture to show children as well, so they can see where they, where are the best places to sort of stroke cats. We can also think about using this CAT acronym here.
So when it comes to interacting with cats, we're gonna consider, you know, did we give the cat a choice over whether it wants to interact with us? That, you know, they need to feel in control, it needs to be on their terms. Is the, am I, or is the owner paying attention to any signs that the cat maybe doesn't want to continue, with that interaction?
And also consider where are they touching the cat? Does it want me to continue? And something that I tend to recommend to owners is that they could try what we call the 3 2nd rule, where they offer like a cupped hand, like a soft hand to the cat, see if the cat has a bit of a sniff.
They can stroke the cat on the head, which we know is that kind of green area, sort of chin, top of head, cheeks there where cats release, release their facial pheromones. We know that's where they, most cats don't mind being touched there. And then just.
Gently pull the hand away and wait a few seconds and 3 seconds and see if the cat wants to interact anymore. If they do, fine, we can carry on stroking the cat. If they don't, and the cat walks off, then we're just gonna leave the cat alone.
So they can be some sort of useful tips that we can discuss with owners when it comes to, how we interact with cats. OK, so You can see here on the slide, I've got lots of different stressful events, stressful events for cats that could definitely trigger further episodes of FIC. And really what I wanted just to highlight was that I think there's lots of potential for veterinary nurses to educate owners on, on how to minimise stress with these events.
You know, we could, . You could put together your own information or advice sheets for owners, you can make displays in your waiting room areas. You might record something for the, if you've got a, like a TV, screen in your waiting area, you can put information on your website or newsletters, you know, these are all great places to inform owners on, on how they can reduce stress, in situations where they, you know, the cat might actually be quite stressed.
So. That's something that you could try, or you can just have a look at the IA care website, where there's lots of really useful information on on cat behaviour and wellbeing in general. OK, so let's have a look at using diet or nutraceuticals for cats with FYC.
I will just mention that evidence is a bit limited, but some cats can benefit from these. So, you can, you can try talking to owners about using, supplements. So these might be things such as alpha kazepine, which is a kind of milk protein hydrolysate.
And this works as an axiolytic with, the GABA receptors. And there has been a study that showed that it, it did help to manage anxiety in cats in socially stressful situations. We can also try things such as tryptophan, which is a precursor to serotonin.
This can help to regulate mood and decrease anxiety in both people and animals. So it has the potential to be useful for cats with FIC. And then I've also put about gag supplements here, and you can see I've put a question mark, because I think at the moment, evidence suggests that they're perhaps not as useful as we thought they were.
But maybe when they're combined with some of these other ingredients in certain supplements, they, they may be useful. And, you know, in some cases they may be added to the diet as well. So we might be that we encourage owners to give a diet that contains all of these, and I think actually in some cases this can be easier for the owner than trying to, you know, put all different types of, supplements into the diet or adding, you know, tablets here or liquid here.
But we could also consider, giving wet food to help dilute the urine. I think that's a really important part of managing these, these cats. But it's now thought that acidifying diets are not as relevant as we once thought they were, you know, cats get through white crystals.
Anyway, all cats do. So, you know, it, it, I think combined together, this diet can be useful, but there's just some things that we need to sort of consider really. And some of these diets may also contain omega 3 acids and antioxidants, and they can help with inflammation, which again could be useful.
So. The jury's out a little bit, with, with diet nutraceuticals, but, you know, it altogether, they may be helpful. I would like to flag that we need to be careful that we're not stressing the cat out, trying to give any tablets or or any type of medication as well, because obviously that's not, that's not gonna be helpful for these cats.
Now we know that obesity is a risk factor for cats with FIC so weight management may be necessary. I would recommend considering how you do this, cos it you need to do this in a way that's gonna minimise any stress, so. If we're seeing talking about weight management with these cats, we need to consider how necessary it is for the cat to visit the clinic and what advice can be given over the phone or virtually to help manage the cat's weight, you know, can the cat be weighed at home?
Can you give advice to the owner over the phone or virtually, rather than them bringing the cat into the clinic? Now, we know that wet food is preferable, for cats with FIC, but it's also great for obese cats. So, that can be really useful.
So it's a bit like a sort of a double whammy there. And puzzle feeding can be really helpful as well, cause, you know, it can, help to reduce anxiety and boredom. And you can also use it with wet food here.
So I've just got a little, video here. You can see my, my, my cat monkey there, he's got some wet food on his licking mat. So we can still use wet food for puzzle feeding.
And it usually keeps them busy for about sort of 1520 minutes, so it can be quite a useful tool. Synthetic pheromone therapy, again, I think this could be a useful tool in your toolkit. So we can use Feyway diffusers, or synthetic pheromone therapy diffusers.
So some may help to reduce conflict between cats living together, such as the Feyway friends or Optimum, or just help to improve feelings of security, like with Feyway Classic or Feyweight Optimum as well. So all of these can Help to with your management, your management protocol for cats with FIC, we need to make sure we use them alongside other management methods such as increasing, water intake and also managing stress. Just using them on their own may not be particularly effective, but they, they, they definitely do have their place.
As I mentioned right at the beginning of the of this webinar, some cats will benefit from referral to a veterinary behaviourist or clinical animal behaviourist. It's something that I think does sometimes get forgotten about, but we do need to consider it. So if your advice or interventions don't seem to be working, then we need to consider referral, because this may help to reduce further episodes of FIC.
If you're finding that the caregiver or owners' corporation is a bit challenging, again, this is where clinical animal behaviourists come in because they have that those skills and that training to identify any barriers and provide ongoing support. And what they will do is work with the owner or the caregiver to and the veterinary team to, to help manage this cat because they've got more time than we have and they can, help to find solutions. So if you're not sure where to look, just go over to the ABTC website.
And there's a list of behaviour practitioners on there, and I would recommend looking for someone, that is accredited for, giving, a clinical animal behaviourist for giving advice specifically for, for cats. So just to summarise, feline idiopathic cystitis is a complex multifactorial condition of young to middle aged cats. Individual management is key here, there, there isn't necessarily a one size that fits all.
We know that comorbidities are common. This is due to the effects of stress affecting other body systems, so cats with FIC are more likely to be affected by disease of other systems too, not just the urinary system. And that reducing exposure to physical and environmental stresses, as well as increasing water intake is vital for managing these cats.
In fact, I'd say they're the two most important components of management. And veterinary nurses play a vital role in helping owners to manage cats with FIC. You know, I think we can make a really big difference, not just to the cat's quality of life, but also, owners really value the support that we give.
So that's the end of the webinar. I hope you've enjoyed it. Happy to take any questions.
