Top practice tips for the feline patient (Proceedings)
What is a cat? What characteristics are different for this species than we are or dogs are? Only by better understanding our patients can we provide better nursing care. Working with a species that has not evolved with a social structure similar to ours provides interesting challenges to the practitioner of veterinary science working with cats. Cats are able to function completely efficiently as a solitary creature. Cats do have complex and changing social interactions which make for a changing structure, much more intricate than that of a herd or pack species. Cats are also small predators. This has affected their anatomic and physiologic development, which has remained unchanged over several million years. While being predators, their size also makes them prey to other species. This aspect affects how they respond to us in a clinic setting and deserves to be discussed further in this presentation.
Relying on the "fight or flight" or epinephrine response, they escape situations viewed as dangerous. From the perspective of a cat, we are, and what we do is, dangerous. Accordingly, one of the great challenges we see on a daily basis is the frightened and assertive cat. It is essential to remember at all times that this small creature feels more threatened than we do so that we do not become frightened ourselves. Because cats are small, they try to avoid physical confrontation at all costs and attempt to intimidate using sounds and posture as much as possible.
1. Handling the uncooperative cat: a comprehensive physical examination can usually be done using a towel as a protective barrier. Facing the cat away from you is less threatening for him/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. Collection of blood and urine can be done by bundling a difficult cat's forelimbs, torso and head in a towel and using the medial saphenous vein and a lateral approach for cystocentesis. This vein is also a superb choice for catheter placement and administration of intravenous medications.
3. Blood pressure evaluation may also be done recognizing that a persistently elevated systolic value of greater than 170 or 180 mm Hg is probably represents true hypertension rather than the stress response. If in doubt, repeat the value later on during the visit.
4. Elevated blood glucose and glucosuria may be a result of persistent stress. The diagnosis of diabetes, therefore, is dependent on finding and elevated serum fructosamine or glycated hemoglobin.
Being largely self-dependent, cats mask illness and pain extremely well. The signals of problems are often subtle. Listening carefully to clients when interviewing them for the history and their concerns is extremely important. Often clients detect changes intuitively that represent real problems. This is more common, in the author's experience, than the client who is blissfully unaware of significant health problems. By asking open-ended questions, one elicits a more detailed history than using only specific questions. For example: starting with: "Have you noticed any changes in the contents of the litter box?", results in a yes/no answer. Asking: "What does his stool look like?" Provides a useful answer.
One simple technique for detecting subtle changes is measuring body weight at every visit and calculating the percentage change in body weight. By 12–15 months of age, a cat should reach their adult weight. By noting slight changes in weight, either increases or decreases, one can follow trends and hopefully avert significant problems such as lipidosis or obesity and detect malabsorption of nutrients or catabolism of cancer in the earlier stages. % change = previous weight – current weight previous weight
Monitoring body weight in hospitalized cats is invaluable in helping to assess the success of rehydration efforts as well as the adequacy of feeding. Weight gain in the face of fluid therapy without voiding could be an indicator of third space fluid accumulation. Thus, cats in clinic on IV fluids should be weighed at least twice a day; cats boarding or otherwise in the hospital should be weighed daily. The "grumpy" cat can be weighed in towel and, by subtracting the weight of the towel, we get the body weight with being minimally intrusive. Other uses for scales are to evaluate volume of urine produced by knowing the weight of the unused litter box and comparing it to the used box; a postage scale may be used to determine volume of blood in surgical swabs.