Key concepts in senior cat care

PRESENTATION

BROCHURE

Félix Vallejo López

KEY CONCEPTS in SENIOR CAT CARE

KEY CONCEPTS in SENIOR CAT CARE

Félix Vallejo López

Key concepts in senior cat care

KEY CONCEPTS in SENIOR CAT CARE

KEY CONCEPTS in SENIOR CAT CARE

Félix Vallejo López

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AUTHOR: Félix Vallejo López.

FORMAT: 14.6 x 21 cm.

NUMBER OF PAGES: 248.

NUMBER OF IMAGES: 119.

BINDING: hardcover.

RETAIL PRICE

€60

eBook included

This book is focused on all medical matters to bear in mind when dealing with feline patients of advanced age. It directly addresses key concepts for each system and disease entity. Its hallmark is its practical utility. It covers every major topic in senior cat care, including the respiratory system, the endocrine system, infectious diseases and pain management, and maintains a consistent focus on the physiological features and responses to treatment unique to senior cats.

Key concepts in senior cat care

Presentation of the book Félix Vallejo is a founding member of the Spanish Small Animal Veterinary Association (AVEPA) Group of Specialists in Feline Medicine (GEMFE). He has always evinced a passion for feline medicine. He is a great colleague and, above all, a great friend. We are tremendously proud to see his book published. We know by experience that it is very difficult to find a balance between the writing of a medical book and one’s family and work at the practice, but the effort is always worthwhile.

You hold in your hands a complete book on senior cat care. Many hours of study and research went into its making. Even though cats are seen with increasingly frequency at small-animal veterinary clinics worldwide, they continue to represent a daily challenge for clinicians, even those who specialise exclusively in treating cats.

These patients pose a particular challenge due to their tendency to camouflage their symptoms. Thus preventive medicine, where possible, is all the more important in cats, especially senior cats (over eight years of age). Diseases such as kidney disease, hyperthyroidism, osteoarthritis and neoplasms are much more common in the senior stage of life.

This book features key concepts that will aid in properly diagnosing the most common diseases that affect senior cats. Its eminently practical nature will greatly facilitate daily clinical practice at clinics with a particular focus on feline medicine.

We hope that you find it to your liking and enjoy it just as much as we have.

Mª Luisa Palmero Colado, DVM GPCert in Feline Medicine (ESPVS) Certified in Feline Medicine (AVEPA) Vanessa Carballés Pérez, DVM GPCert in Feline Medicine (ESPVS) Continuing professional development diploma in Ophthalmology from the Complutense University of Madrid Gattos Cat Clinic (www.gattos.net)

Key concepts in senior cat care

The author Félix Vallejo López Félix Vallejo López graduated in Veterinary Medicine from the Complutense University of Madrid (UCM) in 1992. He is certified as a specialist in feline medicine by the Spanish Small Animal Veterinary Association (AVEPA) and holds a diploma as a General Practitioner in Feline Medicine from the European School of Veterinary Postgraduate Studies (ESVPS). He also holds a diploma in traumatology and orthopaedics and a diploma in traditional Chinese veterinary medicine (Chi Institute of Europe). He is a founding member of the AVEPA Group of Specialists in Feline Medicine (GEMFE), a member of the International Society of Feline Medicine (ISFM) and a member of the American Association of Feline Practitioners (AAFP).

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From 1994 to 2015 he headed the Feline Area at the Happy Animal veterinary clinic in Madrid. In 2015 he founded The Cat’s Smile veterinary clinic, where he currently works. He also manages the specialised consulting firm www.medicinafelina.com. He is the author of multiple publications in the field of feline medicine, as well as a speaker at various conferences in recent years.

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KEY CONCEPTS in SENIOR CAT CARE

KEY CONCEPTS in SENIOR CAT CARE

Félix Vallejo López

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Table of contents 1. Senior care: understanding ageing Senior animals in daily clinical practice The ageing process How to identify this process in a cat

References

2. Respiratory diseases in senior cats Chronic rhinosinusitis Clinical signs Diagnosis Treatment

Bronchial diseases: asthma and chronic bronchitis

Main types of cardiomyopathy in senior patients Hypertrophic cardiomyopathy Dilated cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy Restrictive cardiomyopathy

Treatment of cardiomyopathy Hypertension Treatment of hypertension

Rerefences

4. Dental care in senior cats Age-associated changes Abrasion Periodontal disease

Diagnostic approach

Tooth resorption or false caries

Treatment

Oral neoplasms

Pleural effusion References

3. Common heart diseases in senior cats Examination of a patient with potential heart disease Auscultation Examination of the eyes and mucosae

Stomatitis and feline chronic gingivostomatitis Aetiopathogenesis Lesions and clinical signs Treatment

Tooth extraction Perioperative considerations Surgical technique

References

Examination of the jugular pulse and veins

Keys to thoracic auscultation Normal heart sounds Murmurs Rhythm and rate

Other diagnostic methods

5. Gastrointestinal disease in senior cats Vomiting Diagnostic approach Treatment

Inflammatory bowel disease Clinical picture Diagnostic approach Treatment

Intestinal lymphoma Diagnostic approach Treatment

Constipation (megacolon) Treatment

References

6. Liver and pancreas diseases in senior cats Feline age-associated hepatic and pancreatic pathophysiology Inflammatory liver diseases in senior cats

Annex References

7. Chronic kidney disease The international renal interest society kidney disease classification system How chronic kidney disease is diagnosed Changes in the kidneys What to do

Treatment of chronic kidney disease Treatment of hyperphosphataemia How to fight anaemia How to manage hypertension

References

8. Pain management in senior cats

Triaditis

Feline osteoarthritis

Hepatic lipidosis

Adapting clinical examination to cats

Hepatic encephalopathy

Drugs for pain

Liver neoplasms Treatment of hepatobiliary conditions in senior cats

NSAIDs Opiates Tricyclic antidepressants Anticonvulsants

Antibiotics

NMDA receptor antagonists

Immunosuppressive drugs

Nutraceuticals

Supportive treatment

Gene therapy

Acute and chronic pancreatitis

Alternative therapies

Treatment of acute pancreatitis

Annex

Treatment of chronic pancreatitis

References

9. Endocrine diseases in senior patients Feline hyperthyroidism

10.Infectious diseases in senior cats Toxoplasmosis

Clinical signs

Clinical signs

Diagnosis

Diagnosis

Treatment

Treatment

Acromegaly

Feline haemoplasmosis

Clinical signs

Pathogenesis

Diagnosis

Diagnosis

Treatment

Treatment

Hyperadrenocorticism (Cushing’s syndrome)

Feline calicivirus (FCV) Virulent systemic feline calicivirus (VS-FCV)

Clinical signs

Diagnosis

Diagnosis

Treatment

Treatment

Hyperaldosteronism (Conn’s syndrome)

Feline herpesvirus (FHV) Pathogenesis

Clinical signs

Diagnosis

Diagnosis

Treatment

Treatment

Diabetes mellitus

Feline coronavirus and feline infectious peritonitis: who is who

Clinical signs

Agent that causes feline infectious peritonitis

Diagnosis

Diagnosis

Treatment

Treatment

References

Retroviruses Feline leukaemia virus (FeLV) Feline immunodeficiency virus (FIV)

References

1 | SENIOR CARE:

UNDERSTANDING AGEING

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KEY CONCEPTS IN SENIOR CAT CARE

KEYS TO THE SUCCESS OF A SENIOR CARE PROGRAMME

COMMITMENT

EDUCATION

PREVENTIVE MEDICINE

REALISTIC PLAN

BASIC SENIOR CAT EXAMINATION Detailed medical evaluation by body system and behaviour (Figs. 3, 4 and 5).

Recording of basic physical parameters: weight, body condition, etc.

Minimum diagnostic test panel: Blood testing: with a complete blood count, blood differential and blood smear.

Blood clinical chemistry: creatinine, urea, ALT, alkaline phosphatase, amylase, lipase, glucose, cholesterol, triglycerides, calcium, phosphorus, potassium, sodium and total protein.

Complete urinalysis: urine sediment, glucose, ketone bodies, bil-

irubin, erythrocytes, leukocytes and urine protein:creatinine ratio (Fig. 6).

Tests for infectious diseases: Feline leukaemia virus and feline immunodeficiency virus in at-risk groups.

Special mention must be made of cats that spend time outside. These cats should be examined more thoroughly.

Determination of systemic blood pressure.

Abdominal ultrasound.

Thoracic and abdominal X-rays.

Specific tests: these include all tests deemed necessary by the clinician for diagnosing the animal, such as T4.

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SENIOR CARE: UNDERSTANDING AGEING |

1

Figure 3. A complete range-of-motion examination of the joints is important for ruling out osteoarthritis, since sometimes pain and discomfort are only detected when a joint reaches its full capacity for stretching.

The patient should be examined slowly and extremely carefully, since a feeling of sudden, intense pain in a feline patient may bring an examination to an abrupt end.

Figure 4. The head and spine, as well as all the limbs, should be examined systematically.

Sometimes signs of osteoarthritis are only found in some joints.

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KEY CONCEPTS IN SENIOR CAT CARE

KEY CONCEPTS IN THE DIAGNOSIS OF INFLAMMATORY LIVER DISEASES (continued) Liver biopsies are essential for confirming the diagnosis and being able to apply the proper treatment. The sooner they are performed, the more useful they are, since in many cases the animal’s condition, especially its

clotting capacity, progressively deteriorates. It cannot be forgotten that the patient in question is a senior cat, and in these cases biopsy without a doubt represents the only confirmation of the diagnosis (Figs. 2 and 3).

Figures 2 and 3. Liver biopsy.

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LIVER AND PANCREAS |

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Box 1 How to perform a liver cytology 1. It is advisable to perform an ultrasound-guided liver cytology, if possible using a 7.5–10 MHz probe to select an area that is representative of the condition. If diffuse disease is suspected, a blind liver cytology may be performed.

2. It is recommended that the procedure be performed under sedation and analgesia. This prevents a risk of the patient moving due to pain.

3. The cat is placed in dorsal recumbency and the area of skin just under the ribs is prepared aseptically.

4. The right side of the cat is avoided (non–ultrasound-guided cytology), since the gallbladder is found at the level of the medial liver lobe.

5. A 22-gauge needle is used with a 2–5 ml syringe.

6. Puncture is ultrasound-guided. Otherwise, the needle is inserted around 2–3 cm into the dome formed by the skin under the costal arch. Suction is not necessary since, in the author’s experience, blood contamination is extremely common. Next, the needle is detached from the syringe, the syringe is filled with air, the needle is reattached to the syringe and the cylinder of material within the needle is expelled onto a slide. If the sample is copious it may be spread carefully; otherwise it need not be spread.

7. Different punctures are performed at different sites until one or two representative cytologies are obtained.

TRIADITIS

The concept of triaditis has no simple definition. It is a multifactorial condition in which concomitant cholangitis, pancreatitis and intestinal disease (duodenitis) are reported. The origin of the process is explained by the special anatomical features of the cat: The cat’s pancreatic duct opens into the common bile duct before entering the duodenum. Any inflammatory or infectious condition may trigger the clinical condition in any of the organs involved.

The proximal duodenum features normal intestinal microbiota. Vomiting may allow the reflux of bacterial material that, on an ascending pathway, may infect the bile or pancreatic ducts equally.

Fasting and various causes of liver inflammation may cause dehydration of biliary material, thereby forming sludge or sediment that is not indicative of disease but is a predisposing factor for poor gallbladder drainage. This may lead to inflammation

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KEY CONCEPTS IN SENIOR CAT CARE

Figure 6. Feline body postures and facial expressions linked to pain.

1. A cat with no pain: calm appearance, no negative response to examination.

2. A cat with mild pain: erect or slightly inclined ears, open eyes.

Relaxed but alert.

3. A cat with moderate to severe pain: slanted eyes, arched back, tense limbs.

4. A cat with moderate to severe pain: head down, narrowed eyes. Sitting or half lying down.

5. A cat with moderate to severe pain: changes in behaviour (aggressiveness in normally even-tempered cats), constant vocalisations.

6. A cat with severe pain: Body stiness, nearly closed eyes.

Lying down. Does not respond to its environment.

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PAIN MANAGEMENT |

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HOW TO PERFORM A CLINICAL EXAMINATION IN A CAT The clinician should dedicate all the time necessary to examination, but at the same time work efficiently and patiently.

Examination should take place in an established site that is relatively quiet and far away from dogs.

If possible, a soft, nonslip surface should be used.

The animal should be immobilised as little as possible.

The entire cat, including its joints and spine, should be examined.

Each cat is complex and unique. Some are easier to examine when their owners are holding them or simply nearby. Others are easier to examine when their owners are not present.

Cats do not react properly to extension of the stifle joint or elbow. This does not necessarily signify pain.

The clinician should perform not only passive tests but also active tests, such as climbing into and out of the office chair, walking, and jumping into the carrier.

HOW TO DETECT THE PROBLEM AT HOME Without a doubt, owners are key in this process. Owners are the individuals who report that their animals cannot jump or climb to places where they could before, or are exhibiting claudication or lameness.

Signs associated with pain, joint degeneration and deforming spondylosis that may be detected by owners are as follows: Difficulty jumping.

Reduction in jump height.

Lameness.

Changes in behaviour, aggressiveness associated with palpation.

Lower activity level and loss of appetite.

Pupil dilation.

Alteration in facial expression.

Reduction in or cessation of grooming and cleaning.

Refusal to be handled and increase in body tension, stiffening in response to being handled.

Inappropriate urination.

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ANNEX

ANNEX PAIN CASCADE Cell membrane phospholipids Phospholipase (inhibited by corticosteroids) Arachidonic acid Lipoxigenase

Cyclo-oxigenase (inhibited by NSAIDs)

5-hydroxyeicosatetraenoic acid (5-HETE) (chemotaxis)

5-hydroperoxyeicosatetraenoic acid (5-HPETE)

Leukotriene B4 Prostaglandin G2

Leukotriene A4

Vasoconstriction Bronchospasm Increase in permeability

Prostaglandin H2

Leukotriene C4 Leukotriene D4

Molecules that maintain a balance in the cardiovascular system

Leukotriene E4

Prostacyclin (Prostaglandin I2) Causes vasodilation Inhibits platelet aggregation PgD2

Thromboxane A2 Causes vasoconstriction Facilitates platelet aggregation PgE2

PgF2α

Vasodilation Worsening of oedema

Adapted from: Robbins, S.L., Cotran, R.S., Kumar, V., Collins, T. Robbins Pathologic Basis of Disease (6th ed.). W.B. Saunders, 1999.

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ANNEX |

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ANNEX ANALGESIC DRUGS IN CATS Drug

Moderate acute pain

Severe acute pain

Moderate chronic pain

Severe chronic pain

Butorphanol

0.1–0.4 mg/kg IV (slow infusion) over one hour or 0.4–0.8 mg/kg IM, SC every 2 hours

—

0.1–0.4 mg/kg SC, IM, IV every 2 hours

—

Buprenorphine

0.01 mg/kg IM, IV, SC, transmucosally every 6–8 hours

—

0.01 mg/kg IM, IV, SC, transmucosally every 6–8 hours

—

Fentanyl

—

0.001–0.01 mg/ kg IV every 20 minutes

—

0.004–0.01 mg/kg IV (slow infusion) or 12.5–25 mg/h patch every 5 days

Methadone

0.1–0.2 mg/kg SC, IM every 4 hours

0.1–0.5 mg/kg SC, IM every 2–4 hours

Tramadol

1 mg/kg PO every 8–12 hours

1–4 mg/kg PO every 8–12 hours

Meloxicam

0.1 mg/kg initial dose 0.1 mg/kg initial dose 0.1–0.2 mg/kg SC 0.1–0.2 mg/kg SC or and and or 0.05 mg/kg PO 0.05 mg/kg PO 0.05 mg/kg thereafter 0.05 mg/kg thereafter every 24 hours every 24 hours PO every 24 hours PO every 24 hours

Carprofen

<4 mg/kg SC every 24–48 hours

<4 mg/kg SC every 24–48 hours

—

—

Ketorolac

0.25 mg/kg IM every 8–12 hours

0.25 mg/kg IM every 8–12 hours

0.25 mg/kg IM every 8–12 hours

0.25 mg/kg IM every 8–12 hours

NMDA receptor antagonists

Ketamine

—

—

0.5 mg/kg IV (slow infusion)

0.5 mg/kg IV (slow infusion)

Tricyclic antidepressants

Amitriptyline (idiopathic cystitis)

—

—

2.5–12.5 mg/cat PO every 24 hours

—

Anticonvulsants

Gabapentin

—

5–10 mg/kg PO every 12–24 hours (neuropathic pain)

5–10 mg/kg PO every 12–24 hours (neuropathic pain)

—

Family

Opiates

NSAIDs

0.1–0.5 mg/kg SC, IM 0.1–0.5 mg/kg SC, IM every 4 hours every 4 hours 1 mg/kg PO every 8–12 hours

1 mg/kg PO every 8–12 hours

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KEY CONCEPTS IN SENIOR CAT CARE

Figure 14. Diagnostic approach to FIP.

Diagnostic approach to FIP Noneffusive FIP Medical history

More common in cats <2 years of age In cats from catteries History of stress (adoption, spaying/neutering) In purebred (especially Persian) cats

Effusive FIP

Alert or apathetic cat Temperature: 39 °C–39.5 °C Abdominal distension, ascites Pleural effusion, dyspnoea Pericardial effusion

Clinical examination

Continuous (more than 4 days) moderate fever Weight loss Apathy, anorexia Enlarged mesenteric lymph nodes Eye signs (uveitis, retinal bleeding [chorioretinitis]) Potential jaundice Potential neurological signs (paralysis, muscle weakness, ataxia, seizures)

Analysis of effusion fluid Colour: generally yellowish, transparent and odourless No FIP ← <30 g/l ← Protein → >35 g/l No FIP← >0.8 ← Albumin/globulin ratio → <0.8 ± total leukocyte count >2 × 109/l Mostly lymphocytes← Cell type → Neutrophils and macrophages Virus detection in macrophages (positive IF) → FIP Virus detected by RT-PCR in fluid → FIP

If effusion not due to FIP Potential presence of bacteria on cytological examination Potential predominance of lymphocytes Potential presence of tumour cells Proteins <30 g/l Albumin/globulin ratio >0.8 Leukocytes >2 × 109/l

Evaluation by ultrasound, endoscopy, biopsy, MRI, etc.

Assess potential presence of: Tumours Heart failure Liver disease Bacterial peritonitis, pleuritis Diaphragmatic hernia

Only some criteria match

All criteria match

Blood testing Treatment of FIP

Nonregenerative anaemia (haematocrit <30 %) Lymphopenia Hyperglobulinaemia → decrease in Alb/Glob ratio High anti-FCoV antibody titre Hyperbilirubinaemia

Specific laboratory tests High anti-FCoV antibody titre in CSF Negative (may still be FIP) ← RT-PCR for FCoV in CSF → Positive Negative ← RT-PCR for FCoV in lymph node by FNAB → Positive

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