Hello. OK. Hi, everybody.
I think you know me. I'm Danielle Gunmore from the Edinburgh Vet School. All I do is cats, and today's webinar is really looking at feline, osteoarthritis, but I'm looking at it from a medic's point of view.
So if you were hoping, you were gonna be learning all about how super vet, makes new legs, then this is not the webinar for you. Although you might find it useful just the same. Brilliant.
So with that, I'm gonna start, and I'm gonna take the liberty. Let me make the pointer look better. There we go.
I'm gonna take the liberty of including pictures of my own beautiful cats because I can. I'm giving the, giving the webinar so I think again, I'm sure you'll appreciate she's a beautiful cat. So the important thing as a starting point is you can't say at this age, you're going to see arthritis.
It's not that easy. Most cases are going to be between seniors and what used to be called geriatric and have now been called super seniors. I thought that was a bit strange, but apparently it's the the owners themselves didn't like the idea of calling the cats geriatrics, so they they got they're super seniors instead.
But that said, you can get arthritis in any age, particularly if there's been trauma. So, Always remembering, ageing is individual. So remember as cats age, you're gonna get a combination of concurrent physiological changes.
So these are just the changes that occur with age and then pathological changes depending on what the individual cat has been exposed to. Obviously, all of these areas are changing, but we're particularly focusing on the skeleton. And as you know, I like to build things around a case.
If you've met her before, then hopefully you remember the outcome. But obviously the content in the middle is gonna be quite different. But Sally is a great case because she kind of multi-factors everything in there.
As you can see, she's a tatty old cat. She's 16 years old. She's a crossbred mog.
And she's aged a lot in the last 2 years. You can see she's stopped grooming altogether. She lives with a Labrador dog who washes her face, but clearly is no good at grooming.
She has been urinating around the house. Interestingly, it's only the urine. Defecation has been happening in the litter box.
And straight away, that would make me think, oh, maybe not arthritis, because the classic, presentation for arthritic cats is they urinate in the box, but they defecate beside it. They're trying their very best to be clean and tidy, but the, the type of litter is wrong. And classically, you can cure that by giving a sandy litter instead.
It tends to be when you're using one of those kibbled wood chip. And if you've ever tried to just push your hands firmly down on kibbled wood chip, it's really uncomfortable. And if you've got arthritis and typical elderly cats tend to be rather constipated, because they've got kidney problems, other reasons for, urinating more.
So they tend to be a little bit on the dehydrated side. And that means that makes the constipation worse. So you've got a combination of constipation and arthritis, which means you've really got a strain quite hard, and, and that really hurts your pores.
Hence, the cats will poop beside the box. So urinating around the house, but pooping in the box, slightly odd. Crying loudly at night, night criers.
I live with two of them. I've got two, very, very elderly cats and it's, it's a trying, it's a trying thing to live with, but she's certainly doing that, and that can result from pain. So I wanna be thinking, hm, could this be arthritis?
On clinical exams, she is a bit dehydrated, so that certainly fits. Cardiac wise, she's got a murmur, not surprising in an elderly cat, but she's got an occasional gallop, and that's never benign. So if there is a gallop, there is something wrong with the myocardium that we need to investigate.
Left thyroid gland seems a little bit enlarged. And you can see without it, you don't need a video, do you? You just look at this little cat.
You can see how bad her arthritis is. You can see her stifles are, are swollen and you feel them, they're bony, very bony swelling. You can see she's really got a hunched back.
So, you know, she's, you can see she's arthritic in the lumbar sacral area and probably the tail head as well. . Hips also had some arthritis.
And while her elbows aren't really sticking out like they sometimes do, she does have elbow arthritis. Thankfully, her copy seemed quite good at the moment, which is something because they tend to start collapsing in elderly cats. Yeah, you know, for sure, from just looking at her, let alone putting your hands on her, you've got a cat with arthritis.
So you've made that diagnosis. Question is, what else is happening and what can you do to help little Sally? So let's think of a problem list because it is important that we don't miss something that we could actually help with.
So we've got inappropriate urination, the cardiac things, the behavioural things, the mild dehydration and the arthritis. These two I'm not gonna talk about very much more until we get back to the other side of a bit more investigation. So inappropriate urination, very common.
But I think it's worth looking at this graph first. The purply colour are cats under the age of 10. This is the vast majority of cats that are gonna present with signs of cystitis, which is what FLUTD means.
It just means the over the umbrella term for all the causes of cystitis. And you can see that stress cystitis is by far the big player. But that's not the case in an elderly cat.
All right. And an elderly cat, infection is gonna play a much bigger role. And then you've got to ask, well, what happens when you get elderly?
What's, what is it that risks that increases your risk of developing . Cystitis. Oops see.
I thought there was another picture on that. And it is because you've got some degree, some reason for polyuria polydipsia. So you have, urine that's inappropriately concentrated, and hence you are far more likely to get a urinary tract infection.
Particularly, of course, if you've got some degree of systemic immunosuppression, which all of these diseases can cause. So yes, we would be very much thinking that little Sally may well have a urinary tract infection because of underlying PUPD. By way of cardiac.
Remember, she's 16, so primary cardiac disease has usually killed the cat before this age, if it's going to. So we're talking about secondary cardiac disease, and we're talking about it secondary to all the same problems that cause the the risk for PUPD plus hypertension, which these, of course, increase the risk of. So all very much fitting together.
And then the altered behaviour, hypertension is what I always hope it is because I can do something about that quite easily. And it's that same bunch of underlying diseases. We also have the degenerative diseases, so cognitive dysfunction syndrome, which you may know, I do quite a lot of work on that, as dementia, so Alzheimer's and cats really.
Deafness has a role to play here and certainly you do see cats that have gone deaf and they shout much more, more loudly. You see it with people, you know, like I I remember my great granddad was always, you know, do you want some tea? And you know, have a cup of tea, and you know, Granddad, don't shout at me.
So, yeah, deafness cats will, will shout more. Cancer, obviously a possibility, but this has been going on for 2 years, so I don't think very likely. Infection, I would put toxoplasmosis in there.
That certainly is a possibility. She is an indoor outdoor cat and used to hunt when she was a youngster, so it could be that she's undergoing immune senescence as she's elderly. It happens.
I see quite a lot of that in my clinic. The clue is always the retina look rotten, they look inflammatory or, you know, there's there's changes there and you just think, oh, what is this? And then you look for the high blood pressure.
You find high blood pressure quite often. You treat that and yet the cat doesn't get very much better. And the retina haven't changed very much and you go, ah, if it wasn't hypertension, it must be toxoplasmosis.
You run the bloods for that and you go, OK. And then treating it, you've got a, a completely different cat at the other end of it, a happy cat, which is great. Urinary tract infections, E.
Coli, that are, we do see some multi-drug resistant E. Coli, but some of them form toxins that can cause signs of dementia, seen in people, see dogs, see in cats too. By way of metabolic changes, by far, hyperthyroidism would be the most likely and it can cause the B vitamins to fall, which will exacerbate neurological problems.
But pain has got to be so important. And arthritis is my big player here. You know, over 85% of cats, greater than 12, have got arthritis.
And if you've been sat, you know, yourself, if you, if you sit and you get a bit stiff, and then you go to stand up, and you go, oh, that hurts. And so it can simply be that the cats are waking in the night or waking during the day, they're crying. So we need to factor that in because we know she's already got arthritis.
So, But let's address the things we know she's got. Then there could be social or environmental causes, separation, anxiety type things, frustration in the home, but nothing in her home has changed, so, we're, we're not looking at that. So, before we come back to our little Sally, I want to think more about arthritis.
But remember, I'm looking at it as a medic. So what I think is interesting, this was a study by Boring Engelheim about the most common chronic chronic diseases of elderly cats. And you've got periodontal disease, renal disease, hyperthyroidism, and then arthritis.
So it was up pretty high. This was an original study done by Vicky Halls, but is now being reworked and improved on. Nothing wrong with Vicky's study, we just repeated it.
So we had 20 years apart, which is great. And the owners, when you ask owners of cats, so this was, over 880 cats of greater than 11 years, and we asked the owners what chronic diseases did their cats have to live with. And arthritis was their biggie with 40%.
And dental disease, then kidney disease, then hyperthyroidism. So you can see they're kind of the same list, similar, but rearranged by way of order. I thought it was also interesting to show you these.
These are behaviours that we asked. We asked the owners what behaviours of your cats? What, what behaviours have they changed.
So this is, we're looking at compared to when they were younger. If we look at time spent grooming, these are the cats aged 11 to 13 years. So, the, the dark grey is decreasing, so there is a decrease in time spent grooming, a few increase, but mostly decrease.
As we get a little bit older, 14 to 16, more cats, reduced grooming, 17 to 19, etc. And by the time you've got to 20 plus, then nearly 80% of the cats have have stopped or have reduced grooming. If we look at time going outside, the same things occur.
As the cats get older, they are less and less willing to go outside. Now, take those two things. Time spent grooming.
OK? Probably could be just feeling unwell. It could be that they've got dental disease and it hurts to groom.
It could be they've got arthritis and it's difficult to move sufficiently to groom. It could be other things, but that'd be my major things. Time not going out.
Well, certainly, if you can't get through the litter box or sorry, through, through the, the cat flap, it's very difficult to move. If you look, watch a cat going through a cat flap, they've got to really lift one arm up, then the other arm up, then the back legs. So you can imagine if you've got bad arthritis, you don't want to go outside.
But also cats become more insecure as they get elderly. They quite often they might have been the, the top cat in the area and duffed up a lot of other cats who are now just relishing the chance to get back at this cat now that this cat has aged and has passed their prime. So it could be that they don't want to go outside because of changes in in social hierarchy out there, just insecurities generally.
Increased house soiling. So this is the, the pale colour, and you can see that's increasing about 60% of house soiling by the time they are 2020 plus, and that is despite the fact that over 80% of these cats had a litter box available. So they they've got a litter box, but they're not using it.
And so reasons for that, obviously, it might be they don't like the litter box or what's in it. People might be put one of those horrible litter liners that will catch laws or a type of litter the cat doesn't like, or it's located in a spot the cat doesn't feel confident in much better a quiet dark corner. But you can imagine arthritis simply not being able to get into the litter box, maybe playing a role here.
So you can see how many behavioural changes in elderly cats may be resulted from arthritis. And the problem is, if you ask an owner, does your cat have arthritis? They might not, well, that was 40% said yes, which is still, you know, it's high, but when we get to a slide a little bit later on.
I'll show the prevalence. It's actually we've already said it earlier, it's much, much higher, you know, 85%, over 85% by the time a cat is, is 12. So why aren't people recognising it?
And that is because it's causing more subtle behavioural changes that the owners don't associate with. That is because of arthritis. So other things we see the cats become more social with people.
That may be because they're not going outside, so they're needing social support from their owners instead. We also see this with dementia. Cats become more clingy, more in need of, of attention.
Fishability with animals, so this is the specifics of the cats, they live with cats and dogs. Some go up. Little bit more go down.
And if you're sore, yeah, a bit grumpy or just unwell. Interestingly, we see agitation, which could be all sorts of things, but arthritis could be playing a role in here. Reduced appetite, so a bit of both for that one, not quite so clear.
Weight falling. Not surprising. Water intake increasing.
That's because they can't concentrate the urine just as a starting point and time spent sleeping. Well, all cats sleep but elderly cats sleep even more. The other thing that owners volunteered very quickly was their cats had increased vocalisation.
And remember, that is what Sally is doing, it's one of her signs. Vocalisation during the day, you can see it increases up to almost 80% of cats increase vocalising during the day and during the night, it slowly increases up to maybe about 70%. So very common.
And when we asked about, and this is in a separate study, why, oh sorry, when cats vocalised, it's about 1/3, 13 and 3rd day, night or both. And we also asked these owners what they thought the primary cause of the vocalisation was. And we did this by asking them to say, what was the cat looking at, etc.
So if they're looking at the owner and crying and then they settle down after a cuddle, that's attention seeking, they're disorientated, so they're in a room away from the owner, just shouting. That's disorientation. If they're looking in then running into the kitchen, that's gonna be food, whereas if it appears to be localised to a particular body part, etc.
Then pain. And you can see that while pain isn't a massive player, cats can attention seek because they're painful, and so telling these two apart can be, can be tricky. So what about how common is osteoarthritis?
Well, although, ventral spondylosis, as I grew up calling it, spondylosis to performance, it's not truly OA because it's not quite synovi. This is seen very, very commonly. people say it's not painful.
I don't know. If you know me, you'll know I'm, I'm, disabled, very bad back pain. I can tell you, you get really stiff and this is gonna cause stiffness, and that causes muscle pain.
So I'm not certain that this wouldn't be painful because, you know, if you can't move properly, you do get muscle spasm, etc. And it's certainly gonna contribute to stiffness and an inability to groom. These little facet joints are osteoarthritic, so that can be something we're missing.
So prevalence over 85%, 12 years, particularly affects stifles, elbows, and hips. But also the tarsi and the copi. But certain breeds are predisposed, and there is this weird association that cats with chronic kidney disease appear to have a bigger risk of OA and cats with OA seem to have a bigger risk of CJD.
They're both inflammatory conditions. Could they be being caused by something similar, infection maybe. We honestly don't know.
Maybe the inflammatory, inflammatory agents that are being released inflammatory mediators from the inflamed joints are then causing, secondary damage to the kidneys. A lot more work to be done, but it is meaning when you're thinking about using non-steroidals in cats, you definitely need to know what their kidneys are doing because of this association. It is usually bilateral and subtle, which is why people miss it, at least initially, and the majority is idiopathic.
We really don't know what the cause is, but you do see other causes, obesity, major player, and we see a lot more of that now, trauma, road traffic accidents, etc. Infection occasionally, mycoplasma or mycobacteria, we do see that. And lifestyle choices, lack of exercise, etc.
Certainly can play, can play a role. Hipsia is a really significant one. This is, my beautiful boy when he was when he was younger, and this is my beautiful boy now.
You can see he's a bit of a scruff bag. I have to clip the fur over his, hips and stifles because he really can't groom them and any amount of, if you tug, it really hurts him because even with gabapentin and and meloxicam. There's still discomfort here, he's really crunchy, etc.
So that requires clipping, and you can see his legs are held at an odd position. This was his radiograph when he was one. This is his radio when his radiograph when he was 4, and I have not repeated it.
He came to the clinic for bilateral tibial crest transpositions when he was a year, because of his hip hip dysplasia and patella relaxation, and then his owners decided they couldn't cope, and they gifted him to me. So you can see he has got the thickened elbows as well, because although the disease is all at the front end, that's, sorry, the back end. I don't know the front end from the back end of a cat.
That's quite funny. So the disease was primarily at the back end. That's of course.
Mean he's really shifted his weight forward and we've ended up having a lot of of disease in the front end. So we have hip hip dysplasia, a lot of crunchy hips, patellar luxation, surgery fell apart on the right, so it's very thickened. He's got some collapsing of his tarsi.
It's not too bad. His elbows are awful. They're really thick, almost as thick as my wrists, and his carpi have collapsed.
So you can see. Elbows thickened and he's got what we call a Queen Anne leg because his carpe have rather collapsed over. And he finds that if he can put something between his back legs, it takes the pressure off his hip, off his hips.
He'll often do this with my wrist, and he'll just put one leg over my wrist. Here, he's just using a blanket. This is a, a, like a, a fold I make up for him every morning so that he can have that to sleep in.
Yes, I pamper my babies. So, in cats. It, it is subtle.
It varies. If you were expecting the things you would see in a dog, or, as you know, I call them the lesser species, you are not going to see crying massively over lameness, you know, soft joint swelling, etc. They're much less likely.
So this is my world, as you know, it's, it's slightly different place from, where dogs rule. So, this is a perfectly healthy cat, but and they gave me this picture. This is a ninja cat.
No problem with hip arthritis there. So you need to ask the owners about lifestyle changes. So, you know, like my cats, are they sleeping in unusual places?
But the most important comes out as a reluctance to jump or reduced height to jump. So if they used to jump up onto say, the windowsill, do they now jump onto the chair before they jump onto the windowsill? A classic or you know, they're thinking about it and they could do the butt wiggle, but then they change their mind and walk away.
They just kind of going, no, maybe not today. So you can imagine that's gonna slow down their playing and hunting. Grooming becomes a major one because they really don't like to groom over the sore joints, but also they can't twist, putting pressure on a lower joint to get to the the upper joint.
That's particularly so with hips. And problems with the litter box, absolutely, cause so many litter boxes have got high sides. And then even if they can get in there, you know, if they're constipated, you know, I already mentioned that earlier, but also they can't drop their bottom properly, they should crouch for, for urination and defecation.
And if, and if they can't crouch properly, then the pee or the poo will end up over the back of the litter box, upsetting both you and them. Other things you might find, altered interaction with people, but tends to be that they become grumpy with other pets and more clingy with owners. Stairs are not surprisingly a major player.
If they've got arthritis in the front limbs, then they don't like to go downstairs, arthritis in the back legs, they don't like to go up. Looking at their toes is really important. We know that as elderly cats or as cat's age, they can't retract their claws as easily because that that tendon doesn't work so much.
Their claws thicken and become very brittle. It can be hard to see exactly where to cut. These are two nails from the same cat, and the owner was so upset, she said, but I don't understand.
Why didn't he tell me? It was heartbreaking little old lady, and she was heartbroken that her cat was suffering and she didn't know. This cat is owned, was owned by a vet.
And again, she had no idea that her cat was, had her claws were disingrown. She wasn't saying anything. Obviously, once we trimmed the claws, the cat's mobility much improved.
So, this is important. And even before they get to this stage, you have these long nails that get caught in things. They click.
When the cats are walking, that's often a a thing to ask. Can you hear your cat when it's walking on lino? And those long nails get caught in rugs, and then, of course, when they catch it, and they tug back, damaging the rug, but also damaging, hurting that their arthritic elbows.
And then not surprisingly, a reluctance to use the cat flap because that's a hard thing to negotiate your way in and out of. So one thing that can really help is a mobility, oh, I wasn't gonna put this slide in just yet. We'll put it in anyway.
. Well, basically, if you can develop a questionnaire and there are some on the line available, well, you can just email me and well, use this one, just reformulate it. And it's useful from the cat, say when the cat's about 8 years of age or so, start getting the owners to complete this prior to vaccination. And it helps them start to think about the fact, oh, maybe there might be some arthritis.
Maybe there might be a bit of dementia. Most important thing is you need to ask. Owners do not volunteer this because they think that there's nothing that we can do, and they worry that we're just gonna suggest euthanasia.
So, If you suspect it, to be honest, yes, if they're being anaesthetized or sedated for any other reason, take some radiographs to prove the point. But you can tell, just feel their joints, watch them walk. It really doesn't require anything more than that.
Certainly a trial, a trial treatment therapy. I'm not advocating, meloxicam per se, just in this study, there was a marked improvement in mobility in over 60% of the cats. And a moderate improvement if you added marked and moderate, over 75%, so we can really help these guys.
If you're gonna take radiographs, you may see all sorts of things, new bony growth, osteophytes, horrible, hip joints, etc. Yeah, you know all the things that you're gonna see. So, what I want to focus on is treatment.
Lifestyle is a really important one. So here's one of my cats. He was already getting arthritic when he was 10, and as you can see, he was a chunky boy.
So I started feeding him with a feeding ball so that I was trying to get the weight off him. So try to reduce the weight before it causes even more problems. And that increased movement, which is great because so many cats start getting a bit sore, they stop moving, and obviously that makes it worse.
Heated beds, really, really useful, and particularly if you're going out all day, or, you know, you know, the house is very cold, so I've been here, in Scotland, to not leave a cat with a bit of a heated bed or at least somewhere very, very cosy is a bit mean, to say the least. Massage can be very useful, and it's not something people think of. And yet, if you ask the owners, do you stroke your cat, you'll, they'll all say yes.
And then, OK, could you stroke in a more focused way? And it's an easy thing to learn. It's an easy thing to teach.
It with my boy, he gets bad muscle spasms, down the backs of his legs. And just gentle massage. To start with, he was looking at me and kind of, I'm not happy, Mommy.
What are you doing? And then after I'd done it a couple of times, he would, he will now come in and ask for me to, to rub his muscles because he knows that it can help. If he gets a spasm, it's like, staff, massage, please.
And I'm very happy to oblige. And environmental change. This is so important.
If I want, don't want you to remember anything else from this webinar, I want you to remember these changes. You're a hard, you know, you can't make a lot of money advising this, but you can really make a massive difference. So you need to think about what the core territory is, and you've got to make sure that there is safe and easy access to all that's needed.
Your classic 5 key resources of food, water, litter box, bedding, hiding places, or entry exit points. Add scratching posts to that. I don't know why I don't put it, it's, it's never listed as a primary, but I, I do believe it is.
And they've got to have resting places, preferably high up, but then they've got to have a ramp or something to get there. They must have a safe hiding place or a way to, to, to escape, and remember, they're gonna be less and less happy using that cat flap. You can developer just a handout from this or just turn this into a PDF and hand it to your clients.
So keeping things all on the same level. If it's not an oxymoron, then raise up the food and water bowl. So really important, very easy to do.
We've got water raised up, food bowl. This is the cheap way of doing it. This is the really cheap way of doing it, but, then he kept pushing it off.
So, I have to get a little frame for her. You can get very posh ones as well. This is because if you think about it, if you've got arthritis in the elbows, carpee, or neck, you're gonna have to bend those joints to, to eat or drink.
And so you're only gonna take just enough food or water, and then you're gonna walk away. And particularly with elderly cats because they are insensitive to thirst, we really don't want that happening. Ramps, steps to avoid jumping, warm bedding that's not made of a material that's gonna catch on their claws, and then easy access litter box is not necessarily shallow, I need to change that slide.
A way of water, the one I would mention was a lot of cats prefer running water. If they've been used to having that and they can't get there anymore, they're gonna go deep, go dry. That's where a water fountain can really help.
They can choose to drink at whatever height they want to. It's comfortable. They often get quite fixated with how and where they're going to drink.
So Chiey had to come in for I131 treatment. I know he's looking fabulous. This is after the treatment.
But he only ever drinks from his pint glass, which meant when he was hospitalised, he was hospitalised with his pint glass because that's what he likes to drink from. And quite a lot of cats are that fussy. I've had one cat that was hospitalised.
He would only drink Avian. So I, it was. Resting place is so, so important.
There's gotta be a place that they're safe. So Charlie here, he's a, he came in for I13 1 treatment and then just discussing with his owner, about him and it behavioural changes and things. And it turns out that he really likes to be the heart and soul of the party, wants to be in the kitchen, which is where their whole life, this family is kind of in the kitchen.
But they've got a new Labrador puppy who keeps knocking them over. So I said, OK, are there any other kitchen cupboards you'd be willing to sacrifice? So this is one of their kitchen cupboards.
And it's had the door taken off, and they've put steps all the way up the wall, all the way down to the floor. So Charlie can just walk up the wall to climb into his climbing to his, box and look down on the world, as is his right. Warm bedding, really important.
So this is Bailey. Bailey loves his, his other conspecifics, but he was cold, even with that fabulous coat. He had really severe lung disease.
And it didn't take long for his owner to realise he was spending his time sat like this. So she did what any good owner would do, which is get a lovely fleece and put it in front of the fire. This is my little lady, sleeping on what was a clean duvet, but it doesn't take anything expensive.
Steps and ramps. I really can't overstress these. So here is a transition for, for it.
So this is more like my baby. And initially when he was 14, this is when he started not being able to get up onto the bed. It is quite a high bed.
So I bought him this box and that's all his toys are inside it. But then that became not enough. So my friend John built this for him.
It's gorgeous. But then one day, I was actually lying in bed. My back was playing up.
And Mort fell through as he was climbing up. He, his back legs fell through, and it was horrible. It was just, it was just horrible because I was desperately trying to get out of the bed to catch him, and he's hanging by his back legs from, he's got his back legs the other side of the steps.
And it was just horrible. So I called my friend John, and he's a complete fiophile. I said, John, what do I do?
He said, look, I'll bring a few things. So he brought these make do and mend, which you can see my guys liked very much. But then at the weekend, he came back with this very posh one.
I haven't yet got a picture of more on it, but each step is much, much wider, covered with a non-slipy fabric, and each step overlaps the one below, so you can't slip down. So there are all sorts of things out there, bespoke and homemade. This is, my friend John, these are his cats, and you can see he's absolutely besotted.
But what he did find was these circular sisle covered steps start being a problem as as Tomba got bigger, so got older, he was slipping on these, so John changed them for flat ones. This is Nimbus watch out spot. This is a cat called Piha.
It steps up onto the chair, and this is with Daisy's. She was still pretty good. She could make it up to there because that was her favourite spot to, to rest.
Then we're talking the boxes, oh, should have gone back, sorry. We've got all of these upright scratches here. As cats get older, that can be difficult.
So you can get these cardboard box, low scratches, and they often have toys in underneath, which is what he's playing with. Then by way of litter boxes, I really like this one, which is a huge one, and you see it's high all around here, which means you don't get pee or poo all over the wall, but low at the front. If they're really bad, you could just use trays and then the the ward, you can just use trays.
So I don't like that type of litter. And this, have a look at this for a second. Is this a good idea?
What do you think? No, it's actually the litter box from hell, isn't it? You get in there and you can't get back out again.
Resting places, hiding places so important, and they must have their safe places. And when they're in their safe places, that what we should call them is safe haven, then, you know, no children should pull them out, no pulling them out to give them medication or anything like that. It's their safe, secure place.
The next question is, do you let them out? A lot of cats, as you could see from my data. So, I should have said that's all our recent data that I was showing you, but I guess you.
So Some cats do still want to go out. Toby, this was Sarah Kaney's old boy. He still wanted to go out, but he didn't feel secure enough on his own.
So she would go out and, and sit on the step, to make him feel secure. He just wanted 5, 10 minutes each day, unless it was raining. So, whereas my boy wanted to go out, but he wanted me there.
So that's actually it's my husband attached to his lead. Or you can make it safe by having a proper securing the the garden. So this is a a a a wire that goes over the top and there's a walk space along.
There's that space and it's a lovely place for cats to sit, watch their garden as a little Scottish fold just here, but they, no cats can get in, they can't get out. This is pie whack it, his place, he likes to sit on top of the garage, and he couldn't get there anymore, so they built a ramp for him. Here we've got a very posh enclosure that is very, very bland, but this is when it was first built, it's got all sorts of nice toys in it now.
When it comes to playing, their toys need to get smaller and lighter, easier to use. I obviously would prefer we don't have any, rodent consumption, not good at all. We'll leave that, I think.
And sometimes they want companionship, but what they don't want is a new companion. All right, so if they lose one, they may grieve. It rarely means they want a replacement in a hurry.
So that's all the environmental things, and I know you might think I kind of late but the point, but I just really want you to be giving your owners that information because they'll think you're great. They won't have thought of most of those things themselves, and it makes a huge difference to the cats. So what other things we've got diet.
So one would be Hills JD. It's got all sorts of things to reduce inflammation, improve cartilage, etc. Etc.
Etc. And in one open label study, over 50% improved mobility after two months on it. And then this study was a randomised study of more severe cases, about 40% placebo effect or just a better diet, but 60% significant improvement.
But other diets you've got up there and they're all sorts of ones that have got mobility with something else, things like that. You've got mobility and losing weight, all sorts of things. So there's great combinations now.
This one I really like because they used activity monitors and showed that this diet, the cats improved and moved around much better. What about drugs? Well, NSAIDs and obviously, there's on your, I tend to use meloxicam because of its eminent titratetability, and you really want to get down to as low dose as possible.
There is a study, two studies now, and then, sorry, two studies, and now we've had a summary document in JAP very recently that does say, yeah, if you use low doses of meloxicam, so 0.02. Milligrammes per kilo a day rather than your standard 0.05, so a half dose, and sometimes even a little lower, then it really doesn't affect their, their kidneys, certainly not negatively, possibly it's a positive effect and that really can be considered.
But obviously you do always need to think about risk of dehydration. If the cat's kidney disease becomes unstable, you must stop it. And if the cat doesn't, it doesn't eat that morning, then again, you need to stop it.
So no food, no drug. What about chondroprotectants? There's loads of those out there.
Well, there's no studies, not in cats, but certainly in dogs, starting to look green lip might be good. And certainly in people, green lip muscle has been shown. Scientifically, yes, it can really benefit humans with knee arthritis.
So I think it's a possibility. And certainly from trying all of the different ones with my cats and getting other people to try them too, I'm really happy with Youmo. And Youmove is the only one that's got green lip muscle in it as well as other conrants.
So chondroitins, so that is my preferred. It's also very palatable. You can just sprinkle it on the top of of dinner like pepper and the cats will take it.
So if it's gonna work, I think it's gonna be much earlier cases, but it's definitely worth considering. Other drugs Analgesic. This can be very, very sore.
So my preferred is gabapentin. But a big part of that is because now we can get hold of instead of tablets or capsules, we can get hold of liquid and you can get hold of the gabapentin chicken flavoured liquid from Bova laboratories, and my boy lives on it. I made a huge difference to him.
Whereas we've tried tramadol, but like so many people that these tablets are very bitter. So it could be harder to get them into cats. Unlike in the dog, where less than 50% of dogs will benefit from tramadol because of their metabolism, which is a bit higher in cats.
You've got a manadine as well, but again, it's bitter whether you use the liquid form or the the tablets. So I have problems with both of these for compliance, whereas the gabapentin, I don't have the same problem. Some people might use tricyclics, I don't, I've been really happy since we switched to gabapentin.
Opiates are certainly a possibility as well. Bop is the easiest one to use. I know people always want to put it, into the mouth on the mucous membranes.
But what you can do is, because a lot of cats got dental disease, don't want you doing that. If you get a flat plate, oh, it doesn't matter the shape, to be honest, and just put a smear, just a smear of liquor licks, if they're like licky licks or a favoured jelly or sticky type, liquid, viscous liquiddy type stuff, and then drop, literally drip the buprenorphine on top, then give it to the cat. And the cat will lick and lick and lick.
And you'll see in 20 minutes' time, it's got the big pupils and it's much more comfortable. So that is another way of getting it into them. Obviously, that bowl must not be allowed to have access to children or any other animals.
Another paper that came out, oh, I meant to put the reference, I'm sorry. This is using very high doses, whereas a standard dose would be 0.02 mcg per, sorry, that should say kilo.
I'm very, very sorry that should say kilo. So we're talking per kilo of cat. I'm very, very sorry if that.
Stick on it. This is a big dose. But those two doses were pretty similar and it was given subcutaneous and it lasts about 24 hours.
And I found with my boy at nighttime that that can really help him. I haven't had any joy of fentanyl because keeping it on cats is tricky. What we don't have access to yet, but obviously you've got dogs, you've got the Galloprant, so the prosbanding receptor antagonist.
There are studies on cats. It is looking good, but as yet, no licence for cats and no advice to give it to cats yet. And both of these appear to be not with non-steroidals.
This is the, anti, nerve growth factor, monoclonal. Again, there is a feinized one of these. It is looking good, but as yet, nothing for cats.
By the time I'm giving this webinar again, I think we'll have these two, and this is the one I want, where you can give one injection for, for 6 weeks. Then other things you can try and do, which might help keep track of time, which might help, but we don't have data. Obviously, I think I've mentioned some of these, so increased movement, etc.
Warmth and massage. I've already mentioned, physiotherapy can be very, very beneficial. So, it really is if you've got someone in the practise who is interested in this sort of thing, particularly if they've been doing it in the dog, then yeah, let's start offering it with the cat.
Hydrotherapy, I'm not sure. I've never seen a picture of a cat that looked happy and I've never seen it done in real life, but I guess some cats might cope. Laser therapy, again, I haven't used this or the ultrasound therapy, but I do know that, some people have.
Some people are, are confident and competent with it. Certainly, I've had some ultrasound therapy on my own hands. I have bad Dupatrons or had at one point, my hands went into claws, and that, plus the steroid, of course, that I had injected in my hands.
Maybe it was the steroid that worked. I don't know. But these are potential offerings.
Acupuncture, and tends. So this is, Sam Lingley, like Sam Lindley, doing tends on this cat. That cat's not sedated.
This cat was appeared vicious. He was so sore. He didn't want, he was attacking people because his back hurt so badly.
I couldn't do anything to help him. Everything I did just didn't work. And it was, we're talking euthanasia now.
So I said, look, one more thing, let me have Sam take a look at it. And the first time he was literally getting out of his box was so difficult, so we did sedate him. The 2nd time.
He came out of the box, but he was wary. He grumbled a bit as the needles went in, but he was fine. Third time, this is him.
He just came out and lay down. It was like stick needles in. Do you, do your work stuff.
And looking carefully, you can see this is one of my patients again, back pain, and she's got little needles in all the way down, definitely not sedated. And that was I've forgotten which one of our fabulous people did that. I'm so sorry.
We have 4 people who can do this now at work, it's just, oh, brilliant. I, I apologise for forgetting it. I, I, I will remember in a bit.
Ultimately, what we're not offering yet, but we are starting to, to do the work for is stem cell therapy because, that has been shown to have potential usefulness. So, give me 6 months a year, maybe we'll be offering that. And then the other thing that, that we can do.
Is low dose radiation. This is now being used for arthritis in people, and a new linear accelerator is very low power, so it it can be set to very low power. So that's another possibility.
But all of these things have a place, or at different people working on generative place for them. Surgery, as I said, I'm not gonna be talking about surgery. Really, they are our salvage procedures.
And that's just a brilliant photograph. So, investigation of old cats. We need to always remember they're unlikely to just have one problem, all right?
They're gonna have multiple interacting diseases. At the top 3, kidneys, diabetes, and hyperthyroidism all cause PUPD. So the cat is gonna need to pee more often.
Combine that with arthritis and you're gonna have inappropriate urination. Constipation or diarrhoea, combined with arthritis, you're gonna have inappropriate defecation. Hypertension.
Cognitive dysfunction, those two are gonna make the cat even more confused. And if you're confused and painful, then again, more likely to forget where the litter box is, that sort of thing. So all of these very common in elderly cats, and you need to know what any individual cat is suffering from.
This is Toby, and you can see he's got the classic carpal collapse and look at the length of those toenails. So you need prompt and, ideally prompt, certainly full investigation. Get the owners on board.
They love their cats. One of our findings, in the, the study that I was showing you right at the front was 96% of owners, despite all those behavioural changes, 96% said they love their cat as much or more than they did when it was younger. People don't want a cat.
They want this cat. And they really want us to let them have this cat for a little bit longer with good quality of life. So they're usually very happy to be got on board.
We need to monitor weight change, food and water, urine and faeces, etc. And it does all need to be tailored. So some cats, they're really, they're really showing very little problems.
Seeing them every once a year, twice a year would be plenty. Others, much more complicated cases, you're gonna need to see more frequently. I already showed you this questionnaire.
This is a clinical meteorological instrument, a great phrase. There's a number of these, there was a study in vet record last month. Where they compared 4 different ones that have been, well, that are available, that have been published and Duncan Laels one on the feline musculoskeletal pain index came out best for ease of owner compliance of completing it and completing it, repeatedly in a way that that works very, very useful.
Body weight change, really, I know, I know, you know, it's one of the things that I have a real thing with. Elderly cats are likely to be losing weight. Their guts don't work as well.
They can eat up to 25% more food per day because the guts don't work. They're just not as good at absorbing food. So we really need to be looking for that.
I've got a patient in at the moment. OK, he's only 2, he's not an elderly cat, but when we calculated his weight change, he's had a 30% weight change in less than 6 months. That's, it's awful.
If you have had a 5% or more weight change in any time frame as an adult, whether it was a week or whether it was a year, adults, mammals. If you're not lactating and or hibernating, etc. There shouldn't be that much weight change.
Obviously, as humans, we do dieting and things, so that's different. But for cats, there shouldn't be that much change. So if it's 5% or more, you need an investigation.
We need to know before we take bloods or anything. We want to know there's not high blood pressure because if you take high blood pressure or a cat with high blood pressure and restrain it for bloods, particularly if you take the bloods from the, the jugular, you have a real chance of having increased blood pressure causing a stroke, which can be fatal. And I know because I have done it.
So don't do that. Please don't do that. Obviously, once you know the blood pressure is fine, then you're gonna take all the bloods we need and we need to look at urine thoroughly as well.
And then depending on what we find here, we'll do other things. Just a few pointers, looking for thyroids, don't lift the chin up too high. The cats are gonna resent that, taking blood pressure.
Hold the elbow at a relaxed angle. Do not hold the arm out straight. That's gonna be bad on the shoulder and bad on the elbow, and do not put the cuff above the elbow.
All right? This is all much more comfortable. He's not being restrained.
He's not overly happy, but he's not being restrained. So these are some fabulous videos by Neil Geddes showing how simply, now can I do it with that? No, I have to go back now.
Oh, how do I do that? Oh, good question. Point to options laser pen, highlighter.
Oh no, how do I do this? Maybe I just click on it again. Yes, yeah, I open it up.
So you can easily check a cat's mobility, whether it's visual, etc. Just by putting a few boxes down and let the cat walk around. The cat is obviously visually, he's seeing things, he's not bumping into anything.
You can check vision with cotton wool balls. You don't need to have, a, a, a diploma in, neurology, etc. To have a decent assessment of an elderly cat just walking around.
when Adam was still with us, he asked me, so, he was on Dingle's bets, he was setting up the Dunfermline, Healthy pets facility, and he asked me to come and have a look at it, and did I have any suggestions? And I said, well, put steps up the wall and put the scales at the top, because cats like to walk up steps and that way you can test their mobility. And he also asked what colour, and I foolishly said, oh, I don't know, something fun like purple.
He did purple. So Sarah Kaney works at that facility and has given me these pictures. So I just love these.
So this is cookie. Now cookie. Oh, They didn't know Cookie, they didn't think Cookie was lying.
And yet, as you see cookie going down, you can see elbow particularly is uncomfortable and you can see the, the elbow and the, the carpet, you can see both of those. So if I, few more, this is Boudica and again. Boudica, they didn't think she was lying.
OK, she's also obese, which doesn't help, but you can see her hind limb hind lamps are really not good. And we've got Leo, so I've met Leo as well, and you can see he's a big scaredy cat. So when she tried to get him to go down the stairs, a lot of cats will just go up the stairs straight away.
But if not, then you can get them going down the stairs. But remember, you actually want both because that tests arthritis and different things. He, he didn't want to go.
So you see, he's anxious. Oh that's there in the background, so he can he's he's salivating going, oh, I'm scared. So how do you get a scared cat to go down the stairs?
Yeah, you're right, just put his basket at the bottom. You can see actually, his mobility is not bad at all. So let's finish off with Sally.
So remember her? She's our 16 year old little girl and We were pretty, well, we knew she had arthritis, but we'd also got that thyroid blip. We've got, the gallop, you know, a few things to find.
On her bloods. We've got urea and creatinine are both up with a urines specific gravity when she's fed wet and dry food. You can see she's eating wet here.
It, it's just at the 10:35. Given that she has quite a lot of dry food and she is a little bit dehydrated. So I don't think her kidneys are quite good enough.
She is scared, so her glucose is up. . ALT, all the livery things are up.
Yes, it could be a primary liver thing, . But her T4 is 60. OK, you can argue that it's still within the reference interval, but she's an elderly cat.
We tend to find them in the lower third, just normally, and she's not well. So, as far as I'm concerned, I'm thinking, I think she's actually a hyperthyroid cat as well. Her blood pressure is normal, which is great.
Owners very, very compliant. They wanted us to do as much as we could. So ECG shows tall QRSs, thoracic chest films were fine, echo moderate cardiac hypertrophy.
So yes, it could be primary or it could be secondary to what I think is grumbling hyperthyroidism. It's ticking along. And they wanted an MRI as well, and her brain is shrinking, so the sulky are increasing.
So, almost certainly some cognitive dysfunction. So we've got the cognitive dysfunction, we've got the arthritis and we've got some stress. They remember and the elderly cat is likely to be secondary cardiac hypertrophy, so probably from the hyperthyroidism, because I do think she's got early hyperthyroidism.
Because of these changes. And I do think she's got marginal renal insufficiency. The management of this little lady, her arthritis.
I stop whizzing that around, make everyone feel sick. Environmental modification. The, the thing I really, really want you to take home is the importance of environmental modification.
You can do so much good for these cats, and the owners will really thank you for doing it. So all the things we mentioned, warm beds, shallow litter boxes, or shallow at the front and high at the back. What about massage?
Would would that benefit Sally, actually, it really did. She loves her massage. Ultimately, I wanted more than just that because I felt she really was quite bad.
So I put her onto a diet. I happened to pick JD. If that wasn't enough, you could consider adding a supplement.
What we did, we didn't have the chicken flavoured gabapentin at that time. So she actually, when that wasn't quite enough, she was good for 6 months, but then the crying came back and went, OK, let's add in a low dose of non-steroidals, which we did. Nowadays, I would have put her onto gabapentin first.
And the other diagnosis we've got is, is dementia, cognitive dysfunction, and the treatment. Oh, look, it's the same environmental modification, OK? And that's making the core territory safe, making sure that they can get all of the things they need.
And it's the same diet. Yeah, hey. And that actually improved her know it.
She never needed to go onto the drugs that are sometimes needed with dementia. And then longer term, Elderly cats change, things change. So we need to keep monitoring, to be honest, we should have done, a serum TSH straight away.
We didn't, we left it for a while and yes, she was hyperthyroid, not surprisingly. Regular assessment. She is at risk of UTIs, so we need to make sure about that.
And you don't just make a diagnosis of arthritis and they go away. You need to keep reassessing mobility because things do change. And certainly, ultimately, she did go on to, a little bit of gabapentin too.
Oh, I will say. The gabapentin, I know normally you'd start with 10 milligrammes per kilo, maybe 2 or 3 times a day. With really arthritic cats, I start on 5 milligrammes per kilo, so a half dose just at night.
That's because I don't want them to get wobbly with this and fall off their one of their ramps and hurt themselves. So once they've had 2 or 3 nights like that, then I'll put it twice a day, then I will go up to the standard 10 milligrammes per kilo. The other thing is, cats often have different requirements.
Some cats need a lot more like 40 milligrammes per kilo. We've got some cats on others, the 5 milligrammes per kilo is enough. So hopefully, that was useful for you.
Let's try and keep our elderly cats as happy and healthy for as long as we possibly can. Thank you.