Part 1. Respectful Handling: From the Cat’s Point of View

In many clinics, some veterinarians and other team members do not enjoy working with cats because they believe that cats are unpredictable and feel anxious about getting hurt. By understanding why cats feel that they need to defend themselves, by learning to identify the warning cues, managing the interactions in a positive manner, and making relatively minor changes to what the cat is exposed to, this fear can be reduced.

The basis for working cooperatively with cats is being empathic to their nature and behaviors and trying to imagine what their experience is like. Cats are a species with a social structure different from ours. We need to look at cats differently, slow down, and adjust our interactions. Minor modifications to the physical facility help reduce the strangeness and threats that cats experience in the veterinary clinic.

The goal of these two presentations is to look at how to change the experience for cats thereby removing some of the obstacles to routine feline veterinary care. This is beneficial for cats and their human companions and will also result in clinic growth.

Why Cats Respond the Way They Do

In the wild, the number of feral cats living together depends on the availability of resources. These are food, water, privacy, and safety, toileting areas, and availability of sexual partners. Mice and small birds are single portions; they are not large enough to be shared. After weaning, cats are responsible for feeding themselves. The resource density determines the number of cats living in a given area. In order to reduce conflict and the potential for physical harm associated with fighting, cats have developed an impressive repertoire of signals to maintain distance and protect resources within their territory. This results in little competition and a social structure that does not require sharing or taking turns. Stress is minimal unless resources become scarce. Aggressive communication signals developed in order to keep distance between individuals and to prevent contact with outsiders. Cats need to avoid physical injury in order to be able to hunt and protect themselves. When resources are plentiful, a colony will develop consisting of related female cats with their young, who they jointly defend and nurse. Males are relegated to the periphery and vie for breeding privileges; only one mature tom usually lives with the group.

Many of the behaviours cats show in a clinic situation stem from the fact that while they are predators of mice and small birds, they are prey relative to almost all other larger animals, including larger birds. When they feel threatened, they rely on “fight or flight” and will try to escape situations that they view as dangerous. When they can’t flee, they fight (self-defense) or freeze. From the perspective of a cat, humans are, (and what we do is), dangerous. As a result, we see frightened and defensive cats every day. Cats try to avoid physical confrontation through by using intimidating sounds and postures. This small creature feels more threatened than we do; it is important to refrain from becoming frightened ourselves.

Reading and understanding the cues and signals that cats use is important to detecting incipient fear. This allows us to respond respectfully as well as redirect the progression of an emotion and reshape experiences. We can learn to avoid using signals that are hostile (e.g., scruffing, making shushing/hissing sounds, looking into their faces) when we know how cats communicate.

Feline Signaling: Reading Their Cues

Tactile Sense

Touch is very important to cats. They rub against each other (allorubbing), against us, and against inanimate objects. Whether a full-body rub or rubbing a flank, tail, cheek, or other body part, rubbing is believed to be an affiliative behavior seen between members of the same social group, feline or human. Rubbing is not only tactile, but is also a means of depositing the colony (family) scent. Cats often rub against us; unfortunately, we often misinterpret it as a request to be fed.

Allogrooming (mutual grooming) may precede a playful attack, follow a stressful interaction, and appear to be conciliatory or may simply be grooming. Kneading and treading occurs in adults either as a kitten-regressive behavior or as a component of sexual interaction.

The neck bite/scruffing is used by cats in three contexts: for transportation of young kittens, for restraint during copulation, and for dominance in a fight. Our use of scruffing fits most closely with the last and does not promote shaping safe, respectful cooperation. (See AAFP and ISFM feline friendly handling guidelines.)

Olfactory Cues

The role of smell and scent in feline communication is something we human beings are ill-equipped to appreciate. It has been estimated that the size of the olfactory epithelium in cats can be up to 20 cm², whereas humans have only 2 to 4 cm² of olfactory epithelium. While olfactory signals may be left by several methods, the one that is most problematic for people is urine spraying. This is a potent and important method of communication that we fail to appreciate. Other forms of olfactory messaging are cheek marking an object or individual, scratching to leave scent from glands below the footpads, and midden, (i.e., leaving a deposit of feces uncovered in a strategic place). All of these have several advantages over visual cues. The message persists over time and in the absence of the sender, allowing for remote communication without the potential for conflict that direct interaction risks. This is especially useful at night and in areas with poor visibility. These signals help cats spread out over space as well as time-share territory. The disadvantage of this form of communication is that the sender cannot change the message once it has been deposited; it cannot be altered or removed and no adjustments can be made in response to the recipient’s reaction. So, urine marking in the home is an attempt to signal to the other cats when “I was ‘here’” and to establish a routine so that the cats can keep a distance by time-sharing the same space without needing to come into conflict. Every time we remove the urine, we interfere with this communication!

We have less well-developed olfactory sense; we fail to “read” the signals a patient may be giving us and are unable to fathom the overwhelming olfactory messages from previous patients and substances used in the hospital that the clinic experience presents to cats.

Visual Cues: Body Language (Posture, Face, Tail)

Body language and facial expression are extremely effective at maintaining or increasing distance between individuals potentially competing for resources. This requires having an unobstructed view, adequate ambient light, and, unlike olfactory cues, that the two individuals are in the same space at the same time. Body posture cues the big picture of emotional state but facial expression (eyes, ears, whiskers, mouth, visibility of teeth) provides the finer details and changes more rapidly. In a clinic setting, for us to appreciate the mental/emotional state of an individual, to avoid provoking them and getting hurt, it is extremely important to watch and interpret facial changes.

As a species that generally leads a solitary existence, survival depends on speed, stealth, self-reliance, and outsmarting others. As a consequence, cats may “bluff.” When they act aggressively, they are generally hiding fear; “stoicism” hides vulnerability; subtle changes in behavior mask pain or significant illness. Body postures communicate confidence and physical prowess that may not be present. Keeping a threat at a distance may eliminate the need for a physical confrontation. The arched back “Halloween cat” typifies this façade of confidence. Making oneself smaller, on the other hand, to minimize threat and evade attention is portrayed by a crouch and withdrawal. In these postures, the weight remains on all four paws so that flight or chase remains possible. A cat feeling less fearful does not need to be on his or her feet. However, an extremely fearful threatened cat will roll exposing his or her abdomen with all four feet ready for self-defense. This cat may be screaming while showing all of its weapons (nails and teeth).

Cats have extremely mobile ears. When the ears are forward, a cat is listening and is generally relaxed or alert but not emotionally aroused. Turned laterally, flat “airplane ears” indicate that the cat is more fearful or feels threatened. When ears are back and tight to the head, the cat is feeling very threatened and frightened. This cat will have a partially or fully open mouth and be hissing, spitting, yowling, or screaming. Cats will protect themselves if we fail to reduce the level of perceived threat. Ears turned back but erect indicates the most reactive and aggressive state. In this case, the mouth will be closed and the cat will be emitting a low growl with or without swallowing. This is the cat to be apprehensive of.

Figure 1 Interpreting a cat’s body posture.

Figure 2 Interpreting a cat’s body posture.

Figures from Rodan I: Understanding the cat and feline-friendly handling. In: Little SE, ed. The Cat: Clinical Medicine and Management. St. Louis, MO: Elsevier; 2011:5.

Vocalization

This form of communication requires the direct presence of the recipient. It has the benefit of being easy to adapt from moment to moment. As with other signals, cats have a well-developed repertoire of sounds to convey a need or wish to increase the distance between individuals.

The sounds made for encouraging socialization are a trill/chirrup, purr, puffing, prusten, chatter, miaow, and sexual calling. The cat that is open-mouth screaming is highly aroused but is probably less aggressive than the cat that is close-mouthed growl/wah-wah/mowling.

Cats use a combination of these different signals in any situation. We need to learn to look for all of them and interpret them together.

Part 2. Respectful Handling: Putting Purrspective into Your Practice

Making the clinic environment more “feline friendly” requires imagining how a cat perceives it. The exercise becomes one of identifying potential threats and removing or reducing their significance.

Reducing Perceived Threats in the Hospital Setting

It is important to reduce exposure to true predators (dogs, people, other cats) and to other perceived threats. Visual barriers in the seating/waiting area help to prevent cats from seeing dogs. Covering the carriers with a towel will also help so that cats don’t see each other. Using chairs or ledges, keep kennels off the floor. If possible, have a separate cat-only waiting area. Reserve at least one examination room only for cats in order to reduce the smells of predators and to be able to furnish it with necessary items for examining cats as well as to strive to achieve cat comfort.

Looking over our clinic/hospital environment, what can we do to reduce the stress and threat level of the physical and social environment? What things or events assault the five senses of a cat? How can we make positive changes to these? Table 1 shows a chart that can be completed by the clinic team. For example: Scary smells include alcohol, disinfectants, odours of other carried animals; this can be remediated by wiping the area to which alcohol had sparingly been applied with a damp cloth and using venipuncture sites far from the nose (medial saphenous) when possible. Disinfectant should be allowed to evaporate before a cat is placed/replaced in a kennel. Carry and examine all patients in their own, fresh towel rather than have their smells embed themselves in your clothing.

Table 1. Chart for assessing perceived threats to cats in hospital setting

Handling (Examination, Hospitalization, Diagnostics, and Treatments)

The goal is to handle our patients respectfully and provide an appeasing environment to build positive, long-term relationships. This is achieved by reducing threat and, thus, the cat’s need to react defensively. Avoid doing things in a way that use threatening feline body language or tone. The aggressive cat is upright, stiff-legged, and large; sit down to examine cats.

Never stare a frightened cat in the face: examine cats from behind and, other than for ophthalmic evaluation, avoid direct frontal facial viewing. Using a sideways glance with hooded eyelids indicates a desire to cooperate. A slow blink is a reassuring signal to a cat similar to a human smile.

The aggressive cat growls and uses low tones; use light, upper register tones, perhaps chirruping as cats do when they are relaxed with conspecifics. Shushing a cat to try to calm her as we might a child is the equivalent to hissing at her. Short repetitive sounds should be avoided, since these may resemble spitting rhythms. Purrs, chuffing, trills, and chirrups are welcoming sounds.

When cats feel secure and safe, even just able to hide their faces in an elbow or a towel, they allow most procedures. Try to keep all four of their paws on the floor and avoid changing their body position as much as possible. A comprehensive examination, blood and urine collection, body temperature, and blood pressure evaluation can all be done without changing the cat’s position. Examine her in the base of her own carrier if the lid can be removed. Don’t hang a cat’s forelimbs over the edge of a table for jugular venipuncture. For the frightened individual, additional lack of support under the paws is not reassuring.

Reaching into a kennel to pick up a patient blocks the light; to the cat you appear as a looming, frightening stranger (smells, sounds, visual input). Instead, approach the opening of a kennel from the side so that some light still enters. Do not block every chance for escape; if the possibility to have some control over her environment and situation exists, she will be much more cooperative. Because cats rely on flight and fight for survival and are not reliant on others, when it comes to restraint, the mantra holds true: Less is more! Cats inherently resist intimate handling and restraint. By restraining them, we take away their sense of control and cause them to react. It is very easy to condition negative emotional responses. Scruffing is strongly discouraged as it is an act of dominance that cats may resent. Similarly, stretching is an inappropriate, disrespectful and unnecessary way to apply restraint. Every future experience builds on the previous negative (or positive) experience. Cat bags, masks, and gloves all carry the scents of similarly terrified patients plus other sundry smells (anal gland secretion, pus, blood, halitosis, etc.) A towel is all that is needed to wrap a cat in, in order to protect the handler. Remember, a cat would rather flee than attack.

Train all staff in respectful cat interactions and handling. An excellent and comprehensive resource is the American Association of Feline Practitioners (AAFP) and International Society of Feline Medicine (ISFM)’s Feline Friendly Handling Guidelines, downloadable at: https://icatcare.org/vets. It is well worth reviewing and refining cat examination techniques as a clinic team for a consistent approach, the goal being to make them less threatening. Because value is “perceived worth” and because every visit is a valuable opportunity to educate the client, talk to the client and the cat throughout the entire procedure. Source and provide feline friendly medications, being sure to follow up one or more times with the client to find out how the patient is doing and if the client needs a refresher course on how to administer the medications. Be sure to send home an exam report with home care instructions for the client to refer to. Schedule recheck appointments or the next wellness visit before the client leaves the practice. The AAFP has created the Cat Friendly Practice program through which any interested clinic can raise its cat care IQ. (catfriendlypractice.catvets.com) (VIN editor: Link not accessible).

Meeting Environmental Needs Improves Health

Recently, it has been recognized that emotional well-being is highly dependent on meeting the environmental needs of cats. These include those relating to the indoor and outdoor physical environment, as well as a cat’s social interactions, human and otherwise. In the AAFP and ISFM Feline Environmental Needs Guidelines, five pillars are described that form the basis of a healthy feline environment (Ellis 2013).

These pillars are:

1.  A safe space.

2.  Multiple and separated resource stations (food, water, toileting areas, scratching areas, play areas, perches, resting, and sleeping areas).

3.  Opportunity for play and expression of predatory behaviors.

4.  Positive, consistent, and predictable interactions with humans.

5.  An environment that respects the importance of a cat’s sense of smell.

When these are not met, cats become stressed to varying degrees. Some may express illness (such as inflammatory bowel disease, lower urinary tract inflammation), while others will manifest their distress through inappropriate elimination.

Other Considerations

As cats age, they tolerate less time in the clinic. Siamese cats are especially prone to becoming depressed. Three days may be as long as a cat can stand the anxieties and indignities of hospitalization, even with daily visits from the owner. Consider capping intravenous catheters and send patients home, having them return for outpatient care. Even for in-hospital care, capping catheters off overnight (administering the overnight dose via the subcutaneous route) allows greater ease of movement, avoids alarms, which keeps patients awake. In either case, administer the overnight fluid volume subcutaneously.

Because cats “see” the world in overlapping clouds of smells, we should strive to provide familiar smells and reduce foreign, medicinal smells. Client-worn shirts or toys from home are helpful in cages. Feline facial pheromone may help to reduce stress. Because cats’ sense of hearing is tuned more finely than ours, a quiet and reassuring environment is desirable. Cats should not be exposed to the sounds of predators, namely barking dog, but strange machines (faxes, printers, phones, dishwashers, centrifuges, etc.) should also be addressed. Reducing noises should be addressed when using certain induction agents as some enhance hearing (e.g., ketamine).

Avoid changing a cat’s diet during hospitalization as is likely to result in inappetence and possibly the development of an aversion. If a change in diet is required for therapeutic reasons, try to make that change gradually in the safety of the home territory.

Taking a thorough history is especially important given cats’ tendency to hide illness. Listening carefully to clients and their concerns is extremely important. Often clients detect changes that represent real problems. This is probably more common than the client who is blissfully unaware of significant health problems. By asking open-ended questions, we elicit a more detailed history than using only specific questions. For example, asking, “Have you noticed any changes in the contents of the litter box?” will probably evoke a yes or no answer. Whereas: “What does his stool look like?” followed by: “Would you describe it as hard pellets, moist logs, cowpie, or colored water? What colour is it? When did you first notice this?” will probably provide more useful answers. “Is there anything else?” is a very effective question.

Schedule a recheck appointment to evaluate the effect of any medical or nutritional therapy. Reassessing important variables (e.g., body weight, body condition score, previously abnormal laboratory results) and updating the patient history allows us to provide better care for our feline patients. Care of the client is essential to providing complete patient care. It is only through listening to, educating, and working with the client that we are able to offer the very best veterinary care.

Examples of Practical Applications

1.  If a cat is uncooperative, a comprehensive physical examination can usually be done using only a towel as a protective barrier. Facing the cat away from you is less threatening for her. Confining the cat between your legs as you sit on the floor provides adequate persistent firm restraint that is reassuring rather than frightening.

2.  Swaddling a cat’s forelimbs and torso may help with blood and urine collection, placing the cat in lateral recumbency for cystocentesis and using the medial saphenous vein. This vein is also a superb choice for catheter placement and administration of intravenous medications. If the cat is allowed to have her front end in a sternal position while the back end is in lateral recumbency, she may struggle less.

3.  Allow the client to be with the kitty as much as, and whenever, possible.

4.  Recognize that a persistently elevated systolic value above 160 or 170 mm Hg probably represents true hypertension rather than the stress response. If in doubt, repeat the value later during the visit.

5.  Feliway™ (Ceva Animal Health), a synthetic analog of a feline facial pheromone, may have a calming effect on cats. Spray (or wipe) it into kennels and carriers and even on your clothing before handling an anxious cat. Let the substance evaporate for a few minutes before placing the cat into the sprayed space. Feliway diffusers plugged into treatment and hospitalization areas as well as reception and consultation rooms can help patients relax.

6.  Elevated blood glucose and glucosuria may be a result of persistent stress. A diagnosis of diabetes, therefore, should be confirmed by finding an elevated serum fructosamine.

Part 3. Respectful Handling: Improving Client Compliance in the Feline Practice

While the number of cats kept as companions in North American homes continues to increase, the number of feline visits to clinics has been declining since 2001. Based on the AVMA’s 2007 pet ownership and demographics survey, there were 13% more cats than dogs, yet cats failed to receive the same degree of veterinary attention. In small-animal practices, dogs represented 59% of office visits, cats only 39%. The 2011 Bayer Brakke study further noted three client-driven factors that limited the number of feline visits.

1.  Inadequate understanding of the need for regular preventive health visits other than for vaccination.

2.  Resistance to bringing a cat to the clinic because of the distress caused by putting a cat into a carrier and making the trip to the clinic.

3.  The cost of veterinary care, in particular the frequency and size of price increases. (The state of the economy was a separate, external factor.)

In November 2012, Bayer conducted an online survey of 401 veterinary practice owners across the USA. The Bayer Veterinary Care Usage Study III: Feline Findings noted that 78% of veterinarians believed that better care for cats represented one of the most significant, missed opportunities for the profession. Yet, while 70% of those veterinarians were familiar with the earlier Bayer-Brakke studies, and while most recognized that cat owners consider a clinic visit to be stressful for themselves and their cats, nearly one-third of practices did not have staff trained on how to make visits less stressful for clients. Additionally, relatively few practices had adopted exam rooms used only for cats (35%), cat-only waiting areas that are physically and visually separated from dogs (18%), and cat-only days and appointment hours (11%). The study found that 46% of the surveyed clinics had recently started taking specific steps to increase visits among current feline patients, attract more cat-owning clients, and make their practices more “cat friendly.”

Clearly there is a need to grow compliance among cat owners. However, part of the lack of awareness (at best) or reluctance (at worst) for making simple, inexpensive changes in attitude and facility is that many veterinarians and veterinary staff members prefer, or feel more comfortable, working with dogs than cats. The survey also identified that veterinarians find it easier to diagnose dog cases.

Improving Client Compliance

The verb “comply” means to act in accordance with a wish or command (Oxford), to conform, submit, or adapt (as to a regulation or to another’s wishes) as required or requested (Miriam-Webster). For clients to comply with our recommendations, they have to fully understand, be willing and able to perform the actions that we are recommending. We need to enroll them so that they believe in the importance of these actions. But explanations aren’t enough: on-going caring communication are needed to enhance client compliance.

Many clients believe that cats are self-sufficient, have very few needs, and are low maintenance pets. They don’t understand that cats live as solitary hunters because their prey are too small to share. This means that they lack the resources of a supportive society. To avoid showing vulnerability they hide illness well. Additionally, cats are prey to larger birds and other species. This is critical in understanding why cats so easily feel self-defensive and how to work with cats. Educating potential and existing clients what these subtle signs of sickness are is a huge opportunity for increasing compliance. All veterinary team members also have to recognize that any admission of illness by a cat may signal a problem that has been going on for longer than recognized. Following are descriptions of signs that clients can be taught to look via direct emails, newsletters, the clinic website, and social media.

Subtle Signs of Sickness (adapted from www.haveweseenyourcatlately.com/Home.html and www.cathealthy.ca)

1.  Inappropriate elimination: Regardless of how “deliberate” it may seem to be, when a cat is avoiding or not using the litter box, they are trying to tell you something. The message may be that they are in physical discomfort or psychological distress. Physical problems include inflammation of the bladder or bowel, arthritis, hyperthyroidism, diabetes, dementia. Psychological distress may be due to social disturbance, anxiety due to other animals, children or adults, boredom, or a lack of opportunities to perform the full, natural repertoire of cat behaviours.

2.  Changes in interaction: Changes in how a cat interacts with people, other animals or his/her environment may indicate pain or distress.

3.  Changes in activity: A decrease in energy may be abrupt or gradual. The latter is often attributed to “just getting older,” however, a healthy individual does not inherently “slow down” due to increasing age. A cause for such changes should be investigated. Dehydration, pain from anything, including arthritis, and hypokalemia are some of the problems that should be evaluated. The reverse is also true: an increase in energy in a previously normal cat may be an indicator of incipient illness, most notably, hyperthyroidism or hypertension.

4.  Changes in sleeping habits: This refers to pattern of sleeping (times of the day and night) as well as postures and locations. A cat with pain or with dementia may either sleep for longer or for shorter periods than previously. With FIV infection, the latter may occur. Nighttime yowling suggests a decline in vision or hearing, hypertension, hyperthyroidism, pain, or dementia.

5.  Changes in food and water consumption: This refers to quantity, preferences, as well as changes in behaviours associated with these activities (i.e., where, how often, attitude, amount at each instance, body posture, etc.).

6.  Unexplained weight loss or gain: As gratifying as it is to see rapid weight loss in a previously obese patient, even for those on appropriate dietary regimes, dramatic changes are neither desirable nor the norm. Oral pain may cause inappetence. Gradual weight and muscle loss may be related to ageing but should be monitored and investigated. Weight gain is most often from excess calories but could also be due to abdominal or thoracic fluid accumulation. Helpful tools include repeated assessment of body weight percentage weight change, body and muscle condition scoring.

7.  Changes in coat and grooming: Excessive grooming may be caused by skin irritation (e.g., allergy, fleas, dryness), neuropathy, or be psychogenic (a way to reduce stress by releasing endorphins). A decrease in grooming is often associated with pain, often arthritic or oro-dental. Hairballs may be a sign of dermatologic or psychogenic problems, altered digestive motility, or pain.

8.  Signs of stress: Along with aforementioned inappropriate elimination and overgrooming, signs of distress include hiding, chewing on non-food items, a flicking tail, ears placed further back than normal, unprovoked attacks.

9.  Changes in vocalization: These may be a change in tone, pitch, or urgency and frequency of vocalizing. See above regarding night-time yowling.

10.  Bad breath or smelly coat: Numerous oral and dental conditions result in halitosis; periodontal disease is extremely common in cats. The odour from sialoadenitis, infected ulcers, tumours, abscesses, and anal gland secretions may be spread onto the coat via grooming.

However, even recognizing that their cat has a problem may not be enough to motivate the client to bring their cat in to the veterinarian. Screening to proactively identify disease early and to provide solid medicine can be an even harder “sell” because most people do not like bringing their cats in to the clinic. Many cat owners would rather provide care at home or even skip any form of consultation unless there is “something serious going on!” The second significant opportunity to improve the lives of our patients and be of help to our clients is, therefore, enabling less stressful trips to the clinic.

Getting Cats to the Clinic

It is no fun bringing a cat to a veterinary clinic (for the owner or the cat)! All veterinary team members should be trained in coaching clients how to make the trip less stressful, from the experience at home, during transit, and once they arrive at the clinic. This conversation begins when the client calls to make an appointment or at the first visit with their cat. The American Association of Feline Practitioners (AAFP) has a free downloadable client handout entitled: Getting Your Cat to the Veterinarian (www.catvets.com/public/PDFs/ClientBrochures/Getting-Your-Cat-To-The-Vet-B&W.pdf). (VIN editor: Original link was modified on 1–11–2019). Clicker training can be used to help create positive associations with the carrier. Catalyst Council (www.catalystcouncil.org/) has created excellent videos that clinic teams and clients can watch to learn how to accomplish this.

The frightening experience begins at home. Imagine the scenario from the cat’s point of view: The carrier comes out, your caregiver is nervous, she chases you around and tries to force you into the carrier. You resist and may resort to self-defense. There are new or residual smells of human sweat, fear, maybe even blood. You may feel so anxious that you soil yourself! Eventually you are in the carrier. Everyone is exhausted. Then you are moved into a “car” that makes you move without any intention or action on your part. You may be a bit nauseous; certainly you are scared. You cry out repeatedly. You may vomit or soil yourself. Then the “car” stops and you get carried on a noisy and unfamiliar street and into a place with overwhelming smells and sounds! Help! And you are already aroused and anxious…look out!

We can reduce the stressors the cat encounters, or, in the case of a new cat, prevent them from occurring by teaching or habituating the cat to associate positive experiences with the carrier, the car, and even the clinic. By leaving the carrier out (or using a Hide-Perch-Go box/carrier) so that the cat sees it as non-threatening and enters it for meals, treats, or other rewards, we reduce the initial tension and fight. Taking the cat on short car rides unassociated with the clinic helps to recondition the cat’s negative associations with the clinic. Finally, taking the kitty to the clinic to be fussed over or only to get a treat will help teach the cat that the clinic isn’t necessarily a horrible place.

Taking the Household Pet Inventory

While there are a lot of cats who never receive veterinary care, there are a lot of cats living with existing clients we never see. We don’t even know that they exist! If the cat is well or if the client has had a really bad experience in the past with a cat (or anticipates “bad behavior” from a cat), they are unlikely to voluntarily bring them in for preventive care. By asking whether they have any other cats or pets when they any patient we can identify the un-served animals.

Improving the Clinic Experience

From the client’s point of view: It wasn’t fun to bring her, she isn’t happy about being in the clinic and it isn’t fun watching her be “manhandled.” Once at the clinic, already stressed and frightened, it is extremely important to minimize or eliminate any further perceptions of threats. This requires that we imagine or try to see the clinic from the cat’s point of view. The second and third of these presentations will speak in depth to these matters.

Making the environment more “feline friendly” can be as simple as having visual barriers in the seating/waiting area to prevent cats from seeing dogs. Covering the carriers with a towel will also help so that cats don’t see each other. If possible, have separate cat-only waiting area. Restrict at least one examination room solely for cats to reduce the smells of predators and to be able to furnish it items needed for cat examinations and comfort.

Train all staff in respectful cat handling. An excellent and comprehensive resource is the AAFP and International Society of Feline Medicine (ISFM)’s Feline Friendly Handling Guidelines, downloadable at: https://icatcare.org/vets. (VIN editor: Original link not accessible 1–11–2019). It is well worth reviewing and refining cat examination techniques with the goal of making them less threatening. Because value is “perceived worth” and because every visit is a valuable opportunity to educate the client, talk to the client and the cat throughout procedures. Source and provide feline friendly medications, being sure to follow up one or more times with the client to find out how the patient is doing and if the client needs a refresher course on how to administer the medications. Be sure to send home an exam report with home care instructions for the client to refer to. Schedule recheck or the next preventive healthcare appointments before the client leaves the practice.

The AAFP has created the Cat Friendly Practice program through which any interested clinic can raise its cat care IQ. (catfriendlypractice.catvets.com) (VIN editor: Link not accessible).

Facilitating Compliance at Home

Having a library of YouTube links or making your own clinic “how-to” videos is extremely helpful. YouTube videos made by lay people may have the advantage of being more convincing rather than those by healthcare professionals. Find ones that you and your staff think are best. Ask clients which ones they found and liked. There are many good links.

Examples of useful illustrative clips to have on hand include how to:

• Give your cat a pill (see below)
• Give subcutaneous fluids: www.youtube.com/watch?v=OLOVw35w4Ns
• Administer insulin: www.youtube.com/watch?v=XeZgKLfIJn4
• Measure blood glucose: https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951483
• Use an inhaler for asthma medications: www.youtube.com/watch?v=INF1W8uaPEA
• Feed with a feeding tube: contact the author at hypurr@aol.com
• Change a KittyKollar (video) and Living with an E-tube (handout): www.kittykollar.com

You might also want to include syringe/assisted feeding. Cat caregivers like to show their skills and help others. Compile a selection of reading materials on the internet that you have vetted and feel comfortable with to guide those clients who want to learn more about their companion’s medical condition. Superb client specific books are available from www.vetprofessionals.com. They include: Caring for a Cat with Hyperthyroidism, Caring for a Cat with Chronic Kidney Disease, Caring for a Blind Cat, among others.

Cornell University has a series of videos on a number of procedures and diseases at https://partnersah.vet.cornell.edu/.

They Include:

• Brushing Your Cat’s Teeth
• Giving Your Cat a Pill or Capsule
• Giving Your Cat Liquid Medication
• Taking Your Cat’s Temperature
• Trimming Your Cat’s Nails

Other free videos include:

• Caring for Your Diabetic Cat
• Gastrointestinal Diseases in Cats
• Cat Owner’s Guide to Kidney Disease
• Managing Destructive Scratching Behaviour in Cats
• A Pet Owner’s Guide to Cancer

The ISFM has an excellent owner website: https://icatcare.org/advice. It includes handouts on medical conditions, general cat care, and videos. Websites specific for conditions include: chronic kidney disease: www.felinecrf.org and diabetes: www.felinediabetes.com, www.petdiabetes.com.

Follow-Up

In addition to reviewing discharge appointments of discussing future care, it is helpful to discuss reintroducing the patient to his/her home environment and housemates. Scheduling the next appointment before the client leaves, be it for a recheck evaluation, or for their semiannual or annual visit, encourages continuation of care. Especially useful in a first year of life program, it helps to lay the foundation for a culture of lifelong preventive healthcare.

Even with a motivated and educated client, the likelihood of a successful outcome depends on that client having a relationship built on trust, communication and knowing that the clinic team cares. Follow-up phone calls are a very effective investment of time.

Facilitating Finances

The Bayer study showed that clients want costs spread out over time. Fear of large bills is another significant factor preventing owners from bringing their cats to the clinic. Many practices have wellness plans. Check out the preventive healthcare protocols of Cat Healthy (cathealthy.ca). Directing clients toward pet health insurance that covers both preventive and accident/illness before it is needed is sound medical advice. This can save lives that might otherwise be lost because of hesitation to seek care or a decision to euthanize a pet out of financial concerns.

Summary

Educating clients about the subtle signs of illness, reducing stressful travel, and clinic visits, following up with personalized care, improves compliance. Taking a household pet inventory allows us to discover an unserved pet population. Cat Healthy (cathealthy.ca) has many resources to help you.

Focusing on these unmet needs gives us the opportunity to:

• Provide preventive healthcare
• Detect disease early when we can prevent or alleviate suffering and save expense
• Protect life and enhance welfare
• Build trust with our clients
• Increase clinic visits.

References

1.  Buffington CAT. Cat Mastery - e book from iTunes

2.  Cat Healthy. www.cathealthy.ca

3.  American Association of Feline Practitioners.  www.catvets.com/cfp/cfp

4.  American Veterinary Medical Association. U.S. Pet Ownership and Demographics Sourcebook. Schaumburg, IL: American Veterinary Medical Association; 2007.

5.  Volk JO, Felsted KE, Thomas JG, et al. Executive summary of the Bayer veterinary care usage study. J Am Vet Med Assoc. 2011;238:1275–1282.

6.  Volk JO, Felsted KE, Thomas JG, et al. Executive summary of phase 2 of the Bayer veterinary care usage study. J Am Vet Med Assoc. 2011;239(10):1311–1316.

7.  Turner DC, Bateson P, eds. The Domestic Cat: The Biology of its Behaviour, 2nd ed. Cambridge, UK: Cambridge University Press; 2000.

8.  Crowell-Davis SL, Curtis TM, Knowles RJ. Social organization in the cat: a modern understanding. J Feline Med Surg. 2004:6:19–28.

9.  BCSPCA. Hide Perch & Go. https://spca.bc.ca/programs-services/leaders-in-our-field/professional-resources/for-veterinarians/bc-spca-hide-perch-go-box/

10.  BCSPCA. Cat Sense. www.spca.bc.ca/welfare/professional-resources/catsense. (VIN editor: Link not accessible).

11.  Gourkow N, Fraser D. The effect of housing and handling practices on the welfare, behaviour and selection of domestic cats (Felis sylvestris catus) by adopters in an animal shelter. Anim Welfare. 2006;15:371–377.

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

13.  Ellis SL, Rodan I, Carney H, et al. AAFP and ISFM feline environmental needs guidelines. J Feline Med Surg. 2013;15:219–230.

14.  Lue TW, Pantenburg DP, Crawford PM. Impact of the owner-pet and client-veterinarian bond on the care that pets receive. J Am Vet Med Assoc. 2008;232:531–540.

15.  Loftus L. The non-compliant client. Vet Nursing J. 2012;27:294–297.