Introduction

Veterinary visits can be extremely stressful for feline patients, and a number of physiologic parameters may be affected as a result.^1-4 When evaluating the feline patient, it is important to determine what factors may have been altered by stress, so that an accurate assessment can be made.

Parameters Affected By Stress

Temperature: Elevated rectal temperature just from the trip to the veterinary clinic has been documented in cats. Temperature should be reassessed after the cat has been in a calm environment to confirm fever vs. hyperthermia secondary to stress.

Heart rate: Elevated heart rate is extremely common in the cat in a veterinary clinic setting due to stress. This can be confused with pain, dehydration, shock.

Respiration: Increased respiratory rate in a stressed cat is very common and can make determination of normal respiration difficult. Purring can also look like increased respiratory effort and placing a hand on the throat to determine if the cat is purring is recommended to fully assess the patient (cats can purr even when stressed and no purr may be audible).

Blood pressure: In stressed cats, "white coat hypertension" is a well-documented phenomenon. A determination of hypertension is never made on a single blood pressure measurement unless the BP is >200 mm Hg and/or evidence of target organ damage is seen (retinal detachment/hemorrhage, seizures, neurologic episodes, etc.). More typically, at least three separate measurements are performed if blood pressure is questionable. The method and environment in which the blood pressure is taken are critical to obtaining an accurate reading. A fundic exam should always be performed. Measuring trends over time is also helpful to identify onset of hypertension in patients with predisposing disease.

Blood glucose: Stress hyperglycemia and less commonly accompanying glycosuria can be seen in cats and can result in blood glucose levels consistent with diabetes mellitus. Therefore fructosamine or analysis of a urine sample in the home environment (urine dipstick, glucotest pellets) is needed to rule out diabetes.

Creatinine kinase: CK can quickly rise during a blood draw, particularly if the patient struggles during the procedure, and should not be confused with muscle damage.

Lactate: Elevation in lactate can also occur in the stressed cat and could confound assessing the critically ill feline patient.

White blood cell count: A stress leukogram in the cat can be sufficiently high as to be confused with infection or inflammation.

Platelets: Platelet clumping is extremely common in cats, particularly if the blood draw is not smooth, and an evaluation of a blood smear should always be performed before a diagnosis of thrombocytopenia is made.

Heart murmur: Transient physiologic heart murmurs secondary to elevated heart rate and change in flow velocity have been reported in cats with normal echocardiogram findings.

Managing Feline Stress

Being aware of what aspects of the hospital visit stress cats and how they respond to stress is a large component of working to manage the stress level of their experience. Cats may not experience as many physiologic responses to stress that can be clinically confusing if they are more at ease during the hospital experience. Common stressors for cats in the clinic include other unfamiliar animals and humans, noise, smells and odors, a cage with no option for hiding, unfamiliar caretakers, unfamiliar food and feeding schedule, excessive stimulus from busy hospital environment.⁴

Recommendations that may help improve a cat's veterinary visit include:^3,4

 Acclimatization to carrier before the veterinary visit

 Modify lobby and exam rooms to be feline friendly

 Manage clinic odors

 Manage visual and auditory input

 Consider use of feline facial pheromone products

 Educate clinic staff to speak softly and move slowly

 Educate clinic staff on feline handling techniques

 Educate clinic staff on recognizing feline fear and anxiety

References

1.  Quimby JM, Smith ML, Lunn KF. Evaluation of the effects of hospital visit stress on physiologic parameters in the cat. J Feline Med Surg. 2011;13:733–737.

2.  Rand JS, Kinnaird E, Baglioni A, et al. Acute stress hyperglycemia in cats is associated with struggling and increased concentrations of lactate and norepinephrine. J Vet Intern Med. 2002;16:123–132.

3.  Rodan I, Sundahl E, Carney H, et al. AAFP and ISFM feline-friendly handling guidelines. J Feline Med Surg. 2011;13:364–375.

4.  Carney HC, Little S, Brownlee-Tomasso D, et al. AAFP and ISFM feline-friendly nursing care guidelines. J Feline Med Surg. 2012;14:337–349.