Arthritis in cats: a tale of biotech and a Chinese hamster

Posted on January 30, 2022 by felinepurrspective_u3q4o6

If you search for “monoclonal antibodies”, most of the search results are about COVID-19 and its variants. But did you know that monoclonal antibodies form the basis of the newest treatment for arthritis in cats? This new treatment is called Solensia. Solensia is a monthly injection for arthritic cats that won FDA approval this month. It should be available through your veterinarian later this year.

arthritis in cats: a tale of biotech and a chinese hamster

what are monoclonal antibodies?

Monoclonal: refers to a cell or organism that comes from a single individual or cell.
Antibodies are proteins in the blood that our immune system produces to counteract a foreign substance such as a bacteria or virus (think COVID-19).

antibodies and the immune system

Immune cells in our bodies called B-lymphocytes mount a response to a foreign substance or antigen (e.g. a virus), binding to it and deactivating it. The presence of the antigen and immune cells called T cells activate the B-cells. The B cells then propagate and release antibodies that are able to bind to and deactivate the specific antigen that stimulated their formation!

Monoclonal antibodies are derived from clones or copies of activated B cells. They can be harvested and grown in the laboratory and used to fight infections caused by the antigen they were developed to target.

Where do monoclonal antibodies come from?

Blood cells from convalescing patients: Due to the large numbers of convalescing COVID patients, there was a ready source of blood cells containing B-cells with antibodies to COVD 19 that could be used to make monoclonal antibodies to treat newly infected patients.
Transgenic mice: Mice that have been genetically altered to carry human antibody genes instead of mouse antibody genes are the usual source for monoclonal antibodies. These mice can be injected with a specific antigen and produce fully human antibodies that can be used by human patients to combat that antigen. Being human antibodies, they are less likely to be rejected by the human immune system.

Arthritis in cats: using monoclonal antibodies

Nerve growth factor (NGF) is a protein that is key to the development and survival of nerve cells or neurons, particularly sensory neurons that transmit pain, temperature, and touch sensations.

When NGF binds to pain receptors inside the sensory neuron, a series of events is triggered that ultimately sends a “pain” signal to the brain.

Instead of binding to a structure on a virus, monoclonal antibodies can be developed to recognize and attach to NGF, preventing NGF from binding to the pain receptors on the sensory neruron, blocking the pain signal.

Motion is Medicine

A reduction in pain means our arthritic cats will be more likely to move around more. Increased mobility will strengthen the cat’s muscles, so they can better support and assist the deteriorating joints. Increased activity and reduced pain result in a better quality of life.

Biotech Magic

The active ingredient in Solensia is frunevetmab, a monoclonal antibody that targets NGF. The antibodies are sourced from Chinese hamster ovary cells. Like the mice that have human antibodies instead of mouse antibodies, the hamster cells are “felinised”using recombinant biotechnology. Sections of the hamster antibodies are replaced with their feline counterparts. “Felinization” ensures that the cat’s immune system will not reject the monoclonal antibodies but allow them to function as part of the cat’s immune system.

Of cats and hamsters: no hamsters harmed

Frunevetmab is sourced from the cells of Chinese hamster ovaries. In fact, cells from an individual Chinese hamster, harvested back in the 1950s, produced the cell line which dominates biotechnology today. These cells are easy to propagate and maintain in the lab, providing a ready source of monoclonal antibodies.

multimodal therapy for arthritis in cats

Solensia is a pain medication and does not directly aid in preserving the synovial tissues. Most likely, Solensia will be part of a multimodal treatment that will include drugs and supplements like Adequan or glucosamine that are thought to help maintain synovial tissues in addition to weight loss and exercise.

Unlike other arthritis pain treatments such as NSAID’s, monoclonal antibodies are eliminated in the same way other proteins are, with minimal effect on the kidneys and liver, a concern for our cats with Chronic Kidney Disease.

Treatment using Solensia will consist of monthly injections under the skin. Most cat owners can become proficient in giving subcutaneous injections and treatment can be done in the safety and comfort of the cat’s home.

Thanks to a Chinese hamster years ago and advances in biotechnology, our cats may be able to spend their “ golden years” without pain from osteoarthritis!

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Medication before your cat’s vet visit

Posted on January 23, 2022January 25, 2022 by felinepurrspective_u3q4o6

Many of us (cat owners) dread taking our cat to the vet. There is the ordeal of the carrier and car trip; once there, your cat seems miserable. However, regular veterinary care is the key to a happy and longer life for your cat. Can medication before your cat’s vet visit help?

Not every cat needs medication at the vet. Some cats are fine just having some familiar things with them. Familiarity can help reduce situational anxiety – the anxiety you experience when you are in a strange place. Things we can do to increase familiarity for your cat at the vet visit include:

Training her to be comfortable in her carrier
Choosing a carrier with a removable top to allow examination in her carrier
Getting her used to the car and taking her on some drives that don’t end up at the vet
Bringing your cat’s favorite treats
Spraying the carrier with pheromones (Feliway) before the visit

For some cats, this may not be enough. Your usually nice kitty becomes a raging demon or just freezes like a rock and doesn’t move – both reactions can be the result of anxiety and fear.

I recently took my youngest cat in a for a rabies vaccine and to have a tooth evaluated. Gus accepted handling and food but had a whopping heart rate of 230 beats per minute! He was anxious even though I was there with him.

We would like our cats to associate good things with going to the vet but they may not be feeling well when they are there or they anticipate getting poked with a needle for vaccinations or blood tests. So, when the carrier comes out, your cat may associate it with negative emotions and understandably becomes anxious.

Anxiety actually has a function in our lives – worrying about something in the bushes pouncing on you probably saved a lot of cavemen and feral cats; anxiety can improve your physical and mental performance. But anxiety at the vet clinic does not benefit your cat and can actually make things worse. An unpleasant visit can become an unpleasant memory.

Medication before your cat’s vet visit

Have you ever had elevated blood pressure at a doctor visit? Anxiety before medical appointments is common for people as well as cats. Because cats don’t speak human language, we can’t reassure them and let them know exactly what is happening. It is worth considering medication before your cat’s vet visit to help reduce his anxiety.

Gabapentin and trazodone are two medications commonly used to reduce the stress of the vet visit. These medications must be prescribed by your veterinarian.

Gabapentin

Developed as an anti-convulsant
Has anti-anxiety properties – reduces the release of excitatory neurotransmitters
Is a pain reliever

Gabapentin is commonly used in the veterinary practice to reduce anxiety in cats. There have been a few studies evaluating fear and stress in cats having taken gabapentin – these studies found a reduced CSS (cat stress score) after administration of gabapentin.

The typical dose is 100 mg given 1.5 – 2 hours prior to the vet visit. Frequently, a dose is also given the night before. Doses can vary for individual cats – some cats may do well with a 50 mg dose while others may need 150 mg.

Gabapentin is available in capsules, liquid and small tablets.

Capsules: The capsule is opened and the powder is mixed in a small amount of tuna fish or canned cat food. Gabapentin is bitter and some cats may not eat it in food. The capsules may also be given using a pet piller or a squeeze up treat.
Liquid: The liquid may result in foaming at the mouth.
Tablets: Gabapentin can also be compounded into small, flavored tablets – these can be given in pill treats.

Your cat may be a little sleepy or wobbly after taking gabapentin. You may want to watch kitty near the stairs or jumping up on things!

Gabapentin is a pain reliever for cats – reducing pain may be one of the ways it helps reduce anxiety and fear

Trazodone

Antidepressant that is commonly prescribed for insomnia and depression in humans
One of its side effects is drowsiness

There have been a few studies looking at cats receiving trazodone. One study in particular found that the CSS (cat stress score) was the same in the treated group as the group receiving the placebo. So, trazodone appears to be more of a sedative (makes you sleepy) than an anti-anxiety drug.

Typical dose is 50 mg given by mouth 90 minutes before the stressful event.

Can result in lower blood pressure in cats
There is a risk of serotonin syndrome if used with other anti-depressant medication such as fluoxetine (Reconcile).
Available as a tablet or can be compounded into a liquid or capsule form.

There is increased interest in identifying medications to reduce stress and anxiety in cats at veterinary visits. We should expect to see more medications becoming available in the near future.

Medication before your cat’s vet visit can be part of a low-stress veterinary visit. However, it will be most effective when combined with training to reduce situational anxiety and low-stress handling techniques.

As for Gus, I will make sure to give him some gabapentin before vet visits.

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Giving Your Cat a Pill – Pill Training

Posted on January 9, 2022 by felinepurrspective_u3q4o6

Giving your cat a pill can be a challenge for many cat owners. Often, the pills are bitter or seem too big. The veterinary staff demonstrates the technique but when you get home, you end up with a cat under the bed and the pill on the floor!

I had medicated cats before I became a veterinary technician, using a plunger style pet piller. In tech school, I adopted a 3 yr old Birman cat, Marley, who needed a daily dose of medication for anxiety. It was a daily struggle giving that little blue pill, which could end up in his mouth, but I often found it under the bed or in the hallway on the floor. Marley would see the pet piller in my hand and run.

Giving your cat a pill – daily medications

So, I cringed when my cat Athena was found to be hypothyroid after radioactive iodine treatment. She needed thyroid pills twice a day. She is a cat who could be difficult to handle alone. However Athena liked the soft treats the pill was hidden in, and life was good, for a time….

After a while she tired of the pill treats and we were back to the drawing board. I turned to some low stress techniques – I first offer Athena a treat, then the treat-coated pill, and follow with a few more treats. When I adopted Zelda and Gus, who will eat anything that is not locked up, I finally trained all the cats to sit in a circle and stay, while Athena takes her medication. Then all the cats get treats!

I still have to “pill” Athena occasionally – she does not like having something slid down her throat and quickly goes back to eating the pill by herself.

cat whispering – pill training

Giving your cat a pill for a chronic condition can be different than medicating her when she does not feel well. Say she is diagnosed with pancreatitis or an upper respiratory infection. Either one of these can reduce appetite and then your cat is not interested in treats. This is when having done some “pill training” comes in handy.

If you are doing a treat time every day or a treat time a few times a week, mix it up a bit and give some treats using “pilling” techniques.

A Pet Piller to give medication — A pet piller with a hard treat.

Treats by Pet Piller

Start by offering your cat the pet piller with a lickable treat on it.
Then try offering hard treats using the piller
Get your cat accustomed to having you behind him while giving treats.
When your cat needs medication and he is not well enough to take it in treats, the pet piller will be familiar.

Giving your cat a pill – think outside the box

Sometimes, you need to think outside the box when giving your cat a pill. A few months ago, my youngest cat, Gus, got loose with his harness and leash on when we were hiking. After 2 hours, we found him – his harness and leash were gone, and he was painful when walking. An MRI of his spine showed lots of inflammation but fortunately, no nerve damage. He was so painful that he would growl when he changed positions. His appetite was down and taking a pain medication in a treat was not an option.

I considered using the pet piller since he is familiar with it but then decided to try a technique I had recently seen at a conference on senior cat care. This technique uses one of the popular “squeeze up” treats for cats that come in tubes (Delectables, Churu).

Cut the end of the tube so that you can squeeze the paste up for the cat to lick.

Put the tablet or capsule in the opening.

Squeeze the tube and the tablet goes up into the cat’s mouth with the paste.

giving your cat a pill – practice makes purrfect!

Why wait until your cat is sick to come up with a strategy for giving your cat a pill? Do some “pill training” – set aside some time to accustom your cat to different ways of taking “pills” (disguised treats). When the time comes to give that pill, your cat will be familiar with the pet piller or squeeze-up treat and you will have had some practice with pilling.

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Arthritis Supplements for cats – do they work?

Posted on December 19, 2021 by felinepurrspective_u3q4o6

A cat receives an injection of polysulfonated glycosaminoglycans.

It is thought that almost 40% of all cats have clinical signs of arthritis and 90% of cats over age 12 have damage to the joints that you can see on x-rays. Cats are such masters at hiding pain that we are now thinking that arthritis is there earlier, pain is happening and we may not be able to see it on x-rays yet.

What if we could be proactive and start some kind of treatment before our cats even seem painful? Could we slow the deterioration of the joints? What arthritis supplements for cats are available and do they work?

The motivation behind writing this post was to help my youngest cat, 5 year old Gus, who showed some indications of spinal arthritis in his x-rays. Should I begin a supplement with him? I was astounded by the sheer numbers of arthritis supplements for cats on the market and the astounding claims they made.

arthritis supplements for cats – do they work?

Arthritis supplements for cats on the market now range from supplements used by humans to homeopathic remedies. Clinical trials are rare to non-existent on many of these products. This post addresses the more common products and ones that have had some double-blinded clinical studies done.

glucosamine/chondroitin,
omega fatty acids/ green lipped mussel extract
polysulfated glycosaminoglycans

Glucosamine/chondroitin

Glucosamine occurs naturally in cartilage, the flexible connective tissue found throughout the body – for example, in the external ears and the surfaces of joints. The supplement can be made synthetically in the lab or harvested from the shells of shellfish.

Some human studies have shown oral glucosamine may help with pain relief and slowing of joint degeneration in people suffering from osteoarthritis. However, in general, the results from these studies are not conclusive.

Dasuquin is a commercially available formulation of glucosamine/chondroitin for cats. It is a dietary supplement in a capsule that is sprinkled on food. The product has been evaluated for safety.

A recent double-blinded study of Dasuquin enrolled 59 cats with Degenerative Joint Disease.

All 59 cats were given a placebo for 2 weeks.
Then 29 cats received the supplement for 6 weeks while another 30 continued to receive the placebo.
The cats were evaluated by using an at-home accelerometer (like a kitty “fit bit”), owner observations and vet exams through out the study.
The study showed a strong placebo effect – 78% of the cats were more active while on the placebo.
Cats on the supplement did not show any statistically significant improvement over cats on the placebo.

However, the study did raise some questions:

The “kitty fit-bits” showed that the least active cats at the start of the study became more active on the supplement. Were these cat more painful to begin with?
The placebo was given in the first two weeks of the study when owner enthusiasm would have understandably been highest and owners would have been looking for improvement.

More research is needed – perhaps a different study design?

Omega Fatty acids (fish oils)

Supplementation with fish oils has shown some benefit for arthritic cats. A double-blinded study showed that cats supplemented with fish oil for 10 weeks were more active, going up and down the stairs more, jumping higher, not walking as stiffly and were more interactive with their people. This study used owner evaluation to assess the cats’ improvement.

Fish oil can be given as a dietary supplement (Welactin) or fed as a therapeutic diet, such as Hill’s j/d.

Side effects of fatty acid supplementation include GI upset and reduced blood clotting. There is some controversy over how much fish oil is enough. Additionally, fish oil can add quite a bit of calories to your cat’s diet and could result in weight gain, taxing your cat’s joints further.

Merial’s Antinol for Cats supplement is based on fatty acids from green-lipped mussel extract. There are a number of case studies where the supplement has been given to cats with good results for cardiac and dermatological issues, in addition to joint and mobility problems.

Polysulfated Glycosaminoglycans (PSGAGs)

This product is available under the brand name Adequan. It is the veterinary version of Arteparon, used in humans.

Decreases the breakdown in cartilage. The PSGAG’s allows the cartilage to hold more water, making it resistant to degradation.
Adequan has been extensively studied in dogs and horses for over 20 years and is FDA-approved for these species
Available by prescription.
Given by subcutaneous injection in cats with generally good results.

The jury is still out on most of the arthritis supplements for cats. Given at the manufacturer’s recommended dose, these products are safe and may be effective. Considering the individual nature of pain, some cats may respond favorably while others do not. Once again supplements are basically unapproved drugs so there is not the rigorous evaluation that accompanies FDA approval.

Your vet is your best resource on arthritis supplements for cats. He or she will be able to recommend a supplement or diet that is appropriate for your cat and is compatible with other medications or medical conditions your cat may have. In particular, combining supplements should be done with care – glucosamine, fatty acids and Adequan all effect how your cat’s blood clots.

So, what will I do for Gus?

My vets recommended the Adequan injection, citing the robustness of the canine studies and the fact that it is an injection – there is a greater confidence that the cat will get the supplement. We are not depending on him to eat something.

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Measuring your cat’s blood pressure: why and how

Posted on December 12, 2021 by felinepurrspective_u3q4o6

HDO BP cat — A cat relaxes in his basket during a blood pressure reading at home using an HDO unit. The cuff is on his tail. The blood pressure wave is on the computer screen.

You’ve brought your senior cat in for her regular checkup and the technician asks you if you would like to have her blood pressure checked. Although your blood pressure is routinely checked when you go to the doctor, it has not occurred to you to ask to have your cat’s blood pressure checked. Should you have your cat’s blood pressure measured? How is it done – will it be uncomfortable? Frightening?

Why measure your cat’s blood pressure

As cats age, many develop hyperthyroidism and kidney disease. Other cats may develop diabetes. All of these conditions can result in the heart pumping harder to compensate for the changes. As the heart pumps harder, blood pressure increases and arteries, the eyes, the kidneys, the brain and heart can be damaged.

Left untreated, high blood pressure can result in:

blindness
increasing loss of protein through the kidneys >> shortened life span
disorientation, lack of balance, seizures, altered mentation or behavior, or weakness in the limbs

The best way to avoid these consequences is to monitor your cat’s blood pressure and start treatment if his blood pressure is high.

So how do we measure your cat’s blood pressure?

When measuring blood pressure in humans, we typically place a pressure cuff on the upper arm, inflate the cuff until the flow of blood to the artery is shut off . The cuff is then released, and a wave of blood fills the artery, turbulent at first, then subsiding to a smooth flow.

The human practitioner can use a stethoscope to listen to the sounds made as the blood rushes back into the artery.

The first sound is heard at the systolic blood pressure (the higher number in 120/80)
The final sound is heard at the diastolic pressure (the lower number in 120/80).

We will also use a blood pressure cuff to measure your cat’s blood pressure. This cuff can be put:

on the front leg
on the hind limb, above or below the hock (ankle)
on the tail

Cats’ arteries are much smaller than humans’ and it is difficult to hear the sounds of the blood flow using a stethoscope, so we turn to other methods: Doppler and oscillometric.

Doppler

A Doppler unit measures blood flow.

After placing the cuff on your cat, the Doppler sensor is placed over the target artery.
Piezoelectric crystals in the sensor detect changes in the flow of blood in the arteries and convert these to sound.
Acoustic gel on the sensor ensures good contact so that the practitioner can hear the heartbeat.
The cuff is inflated until the heartbeat is no longer heard.
The cuff is then released and the pressure at which the heartbeat can be heard again is the systolic blood pressure.
Headphones are usually used when measuring blood pressure with a Doppler.

Doppler units give us a measurement of the systolic blood pressure, the larger number in the 120/80.

Oscillometric

Only a cuff needs to be placed to measure your cat’s blood pressure with an oscillometric unit.

A sensor in the cuff detects the pressure pulses in the artery.
As the cuff is inflated, the pulses decrease as flow to the artery is cut off.
The cuff is then deflated and the pressure wave that results as the blood rushes back into the artery is analyzed.

Oscillometric units typically only measure the peak of this wave, the average blood pressure, and calculate the systolic and diastolic pressures.

A High Definition Oscillometric unit records the entire pressure wave, directly measuring the systolic and diastolic pressures. An HDO unit is usually connected to a computer to view the pressure wave and determine if the measurement was accurate.

How accurate is a blood pressure if my cat is nervous at the vet clinic?

Just like people, cats get anxious and nervous when visiting the vet clinic. Blood pressure is sensitive to this and it can be a challenge to measure your cat’s blood pressure.

Putting the odds in our favor:

Most of the time, you should be with your cat during a blood pressure measurement. Your cat knows you and trusts you. Your presence is reassuring and calming.
Allow your cat to settle in for 5-10 minutes – the measurement should be done in a quiet room.
If your cat likes to snuggle in your lap, see if the measurement can be done there. If your cat prefers to sit on his stomach, perhaps a tail measurement is best. If he is comfortable laying on his side, a hind leg may be better.
Using the front leg to measure blood pressure puts the practitioner in front of the cat; curious cats may want to take a nibble at the blood pressure cuff. I prefer that your cat be facing you, her person, who can reassure her. I feel the tail and hind leg work better.
The artery being measured, tail or hind leg, should be at the same level as the heart – so kitty should not be sitting up, but laying comfortably on his stomach or side.

What do the numbers mean?

Again, like people, the systolic pressure is ideally around 120.
Pressures 150 and over can indicate the need for medication.
Your vet may also do an eye exam, looking at the eye with an ophthalmoscope or lens. In some instances of high blood pressure, the vessels in the eye dilate and become twisted; sometimes the retina may be detached, resulting in blindness. If high blood pressure is caught early enough, blindness may resolve with treatment.

My cat’s blood pressure is high but her eyes looked OK. What next?

High blood pressure can be treated with drugs – the most common drug used is oral amlodipine. Amlodipine takes effect fairly quickly and a blood pressure can be repeated in about 10 days and the dose adjusted if needed.
Other medications such as benazepril or telmisartan may be used alongside or in place of amlodipine.

I don’t think the reading was accurate – my cat was too nervous

It is worth investing in a home blood pressure visit. A practitioner can come to your home and get a measurement where your cat feels safe and secure.

Measuring your cat’s blood pressure especially as she gets older will help keep her healthy and comfortable. Without treatment, high blood pressure can have serious side effects, including blindness, seizures, and cardiac damage.

Have your cat examined regularly by your veterinarian, as changes to the eyes or a heart murmur might warrant a blood pressure check.

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Cats and boxes: If it fits, I sits

Posted on November 21, 2021 by felinepurrspective_u3q4o6

Cats and boxes are a purrfect combination. An enclosed space like a box can be a safe place, help keep a cat warm and give him a vantage point to ambush “prey” (unfortunate insects, catnip mice…). Boxes are also popular with other animals – big cats are often given boxes for enrichment at zoos and refuges; dogs also like boxes to play in but some may tend to chew the box up!

Cats will also sit on just about anything, comfortable or not. Anyone who does craft projects well knows that once the fabric is out to be cut, a cat will be sitting on it soon enough. Years ago, cats sat on newspapers if you tried to spread the paper out on the table – nowadays, they park on computer keyboards. Some of this is attention-seeking behavior – Zelda only lets me type so long Sunday mornings before she gets up on my desk and threatens to contribute to the post if I don’t take her for her morning walk.

In 2009, the USPS came up with the Christmas slogan, “If it fits, it ships”. A few years later, a variant of the slogan became an Internet cat meme: “It it fits, I sits”. This gave rise to posts of cats in all sort of places, from egg cartons and shoeboxes, to bowls and sinks.

The Internet exploded again in 2017 as people used tape to outline squares on the floor for their cats to sit in. Cats were “trapped” in all manner of taped shapes, with cat experts offering explanations ranging from cats reacting to new smells (from the tape) to survival instinct, where the cats must investigate something new (the taped square) to determine if it poses danger to them. Some felt that the taped square offered the cat a sense of security, much like a real box.

The phenomenon did not stop here – in 2020, during the COVID pandemic, a woman in the Philippines photographed stray cats practicing “social distancing” – the cats sat on circles painted on the ground 6 feet apart outside a food market.

cats and boxes: optical illusions

It is not surprising that cats in taped squares became the subject of a research study investigating cats’ responses to optical illusions. In a two month study in June-August of 2020, researchers at Hunter College enrolled over 500 cat owners to participate in a study to assess cats’ responses to a taped square, a Kanizsa square (which gives the illusion of a square), and a control figure.

Enrolled owners were sent booklets containing pairs of these shapes that they affixed to the floor. The owners then took videos of their cats’ responses to the shape-pairs and submitted the videos to the research team. They were to do this once daily for 6 days.

The results found that of the 30 cats that completed all six trials of the experiment, only nine of them “participated”, that is, sat in one of the shapes. These cats were just as likely to sit in the taped square as the Kanizsa square. Only once did one of the cats choose to sit in the control shape.

What does this tell us about cats? Are they susceptible to the optical illusion of a square? Do they recognize it as a square? I think more research will have to be done:

Only 9 out 30 cats actually sat in the shapes.
Cats are not as tall as we are and don’t see well close up. Can they see the squares from their vantage point?
I, for one, would like to know how many cats will voluntarily sit in a taped outline – I tried leaving a hula hoop out on the floor to see if any of my four cats would voluntarily sit in the circular outline. I did not have any takers!

This study is the first to use “citizen scientists” (the owners) to observe the cats in their home environments, thereby avoiding stress-induced behaviors that cats can exhibit in unfamiliar settings, such as a laboratory.

Back to cats and boxes…

Cats are practical. They prefer their owners to their owners’ T-shirts. I feel that they would prefer a physical box to a taped outline. A box is a great source of enrichment – it can be a bed, a den, it can be place to hide while ambushing a toy mouse going by. Shelter cats acclimate to their surroundings more quickly when provided a box to hide in.

Boxes that are too small to allow a cat to hide may make him feel good by putting physical pressure on his body, like when we wedge ourselves in the corner of the sofa watching a favorite TV program. Pressure on soft tissue has been shown to promote relaxation and reduce anxiety in both humans and animals.

So, make sure your cat has a safe place – a place he can call his own, a place that is secure, secluded, a hiding place to retreat to, warm in the winter, cool in the summer. It can be a cardboard box in a closet or in a secluded corner!

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Cat dementia – Three cats and three outcomes

Posted on November 14, 2021 by felinepurrspective_u3q4o6

Identifying signs of cat dementia is not always straightforward. In the hubbub of daily life, behavior changes can be subtle and go unnoticed until they are more severe.

Changes in behavior can indicate if your cat’s mental state has changed. The acronym VISHDAAL summarizes the behavior changes we need to observe to care for our senior cats.

V = changes or increase in vocalization
I = changes in interaction with us and other pets
S = changes in sleep-wake cycle: restlessness, night time activity
H = housesoiling
D = disorientation and confusion
A = changes in activity
A = anxiety
L = learning and memory

Three cats – three outcomes

rupert, 18 year old neutered male siamese

I had two senior Siamese cats when I had my first child. A first-time mom, I was frazzled, dealing with the completely new experience of parenting and was not paying as much attention as I should have to my cats.

One day, an acquaintance asked why one of the cats, Rupert, was sitting on the kitchen counter, in a corner, facing the wall. I had been aware that he did that sometimes but when I paid closer attention, I found that he would eat in the morning, use his litter box and then spend the day on the counter, facing the wall. He would come down to eat, drink, and use the litter box but always returned to the counter.

Behavior Changes – signs of cat dementia?

I – Rupert was no longer interacting with us.
D – He seemed confused and “out of it” – sitting on the counter all day
A – His activity had changed – he did not move much from the counter

Diagnosis:

Rupert had lost quite a bit of weight, although he was eating well. My vet diagnosed him with hyperthyroidism, which was a new disease in cats at that time.

Outcome:

Use of radioactive iodine to treat the disease was pioneered about 10 years earlier but it was not commonplace. Surgery was an option but at 18 years of age, Rupert was not a good candidate for surgery and we elected euthanasia due to his declining Quality of Life.

The Takeway:

I suspect that Rupert had moderate to severe cat dementia. The symptoms were most likely apparent earlier and I just did not recognize them. Nowadays, drug therapy for hyperthyroidism is readily available – methimazole is an FDA approved treatment for hyperthyroid cats. Perhaps treatment of the hyperthyroidism would have reduced the symptoms of cat dementia enough for Rupert to have had some more time with us.

Athena, 16 year old spayed female

Athena had been slowing down over the past year, was not eating as well and was spending most of her time sleeping. We had provided her with steps to access window perches and our bed; we also provided her with a heated bed.

Behavior Changes – signs of cat dementia?

I – Although still willing to play, Athena was interacting less with us; she had previously been a “nosy, busybody” kind of cat.
A – Athena no longer went on her daily walk and was less active in general

Diagnosis:

Diagnostic blood work did not show any significant changes over the past year. Athena did not show other signs of cat dementia and would still learn new tricks when hungry for treats.

X-rays showed moderate to severe arthritis in one of her hips and knees. We decided to treat her arthritis pain with the drug gabapentin.

Outcome:

Treatment for her arthritis pain has been a game changer for her; her activity level has increased, her appetite has increased, and she is back to “being in your face” when she wants something.

The Takeaway:

Regular checkups and treatment of chronic conditions can make you and your cat happier! Some symptoms typical of dementia may be due to treatable, medical conditions.

Marley, 15 year old neutered male

cat with food puzzle — Marley works the Poker Box, a food puzzle.

Marley is a friendly, affectionate cat with good health overall. In the past several months, Marley showed some of the behavior changes that we need to monitor in senior cats.

Behavior Changes – signs of cat dementia?

I – Marley had become more clingy than usual and more interactive
D – He seemed confused when playing the nightly game of “treat toss” – he seemed to forget that he was chasing a treat!
A – He did not want to walk outside with us (which he has been doing for years).
A – He seemed anxious and a little fearful. His interactions with the other cats became timid.

Diagnosis

Marley’s senior exam and blood work did not reveal any abnormalities other than a slight decline in kidney function which could be expected at his age.

Marley appears to have some mild cat dementia. Since these changes were mild, we decided to try SAMe, a dietary supplement. SAMe has been shown to be effective at reducing symptoms of dementia in cats in the early stages of cat dementia.

Outcome

About 2 months have gone by with daily supplementation. Marley is taking his daily walk again and is not as clingy with his humans. He is no longer stand-offish with the other cats and is “catching” his treats again when we play the nightly treat toss.

A Final Word…

Cat dementia cannot be cured but it can be managed. With early diagnosis, appropriate environmental modifications, dietary supplements, therapeutic diets, and medication can help can reduce the symptoms of dementia and improve Quality of Life for both you and your cat.

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Cat dementia: How can we manage it?

Posted on November 7, 2021 by felinepurrspective_u3q4o6

At the veterinary clinic where I work, I often hear people say when I ask about their cat’s activity and play, “she sleeps most of the time and meows a lot at night. She doesn’t play – she’s an older cat”. How much of these behaviors is due to “normal” aging? How much is due to other medical conditions or a declining brain?

Cognitive Dysfunction Syndrome in cats or cat dementia refers to the decline in mental abilities associated with aging.

Cat dementia results from damage to the brain. As your cat ages, the the numbers of molecules called free radicals are no longer balanced out by the antioxidants in his body. These free radicals are reactive and cross the blood-brain barrier, damaging cells in the brain.

Changes in blood flow to the brain can also cause damage by starving the neurons of oxygen. High blood pressure, heart disease, anemia – are all conditions that alter the flow of blood to the brain.

How can we tell if our cats are undergoing mental decline? Is there anything we can do about it?

VISHDAAL – behavior changes

Changes in behavior can indicate if your cat’s mental state has declined. The acronym VISHDAAL summarizes the behavior changes we need to monitor in our senior cats, from the most prevalent (vocalizing) to least frequent (changes in learning and memory).

V = vocalization
I = changes in interaction with us and other pets
S = changes in sleep-wake cycle
H = house soiling
D = disorientation
A = changes in activity
A = anxiety
L = learning and memory

How do we sort out behavior changes due to disease and those due to declining mental capacity?

Changes in behavior signal the onset of cognitive decline but they may also arise from other health issues:

Cats with untreated high blood pressure or hyperthyroidism may meow at night (vocalizing).
Cats with untreated hyperthyroidism may be restless and beg us for food (changes in interactions and sleep).
Kidney disease can be accompanied by increased thirst and urination which may result in house soiling (house soiling)
Cats with osteoarthritis may have difficulty accessing the litter box (house soiling).

behavior changes: disease vs Dementia

Regular veterinary exams and diagnostics can identify medical conditions such as high blood pressure, hyperthyroidism, and osteoarthritis. If behavioral changes persist after treating these other medical conditions, your cat may have CDS or cat dementia.

Cat dementia is a “diagnosis of exclusion” – it is the diagnosis that remains after all the other possible diagnoses have been eliminated. Cat dementia will usually have a slow onset and behavioral symptoms will gradually get worse.

Cognitive Dysfunction (CDS) cannot be cured but management can reduce the symptoms and improve the Quality of Life for both you and your cat.

managing cat dementia

environmental enrichment/modification
dietary supplements
therapeutic diets
medication

Environmental enrichment/modification

In the early stages of cat dementia, enrichment increases mental stimulation, leading to the growth and survival of neurons, preserving the thinking processes. Enrichment should be tailored to the individual cat. For example, some cats prefer high places; others are “ground dwellers”. Arthritic cats will not have the range of motion of healthier cats but will still enjoy play that does not require lots of jumping.

Ways to enrich your cat’s environment:

play – interactive play and toys
scent enrichment – catnip, silvervine
food puzzles
motion – climbing (cat trees) and exploring (cardboard boxes)
supervised outdoor access

As CDS progresses…

Environmental changes become stressful and confusing. Cats with severe cat dementia need an environment that does not change much – daily routines and feeding schedules must be maintained. Litter boxes and feeding stations need to stay in the same place.

A cat with severe CDS may benefit from a “room of his own”, with easy access to his resources. Changes that need to be made must be done slowly. If you need to move a litter box or feeding station, do it gradually over a number of days so the cat can still find it.

Environmental modifications

Modifications to the environment of the cat with dementia should take into account the behavior that she is exhibiting.

Cats that constantly beg for food may benefit from a timed feeder at night or treat balls.
Cats with house soiling tendencies may need more litter boxes and ones that are easily accessed, with a lower entry for example.
Cats that become disoriented and confused may benefit from a night light and radio playing soft music.

Dietary Supplements

Dietary supplements in general seek to restore the balance between the activity of antioxidants in the body and the production of free radicals. Antioxidants give up electrons to the free radical, effectively “neutralizing” it so that it is no longer reactive. So, these supplements usually contain antioxidants.

SAMe: (S-adenosyl-methionine) aids in the production of glutathione, an antioxidant. When elderly cats were supplemented with SAMe, there was improvement in cognitive tests. SAMe is best used pro-actively – it is most effective in cats in the early stages of cat dementia.

Proprietary supplements containing vitamins, resveratrol (antioxidant), and fish oils are on the market but there is no clinical data testing cats for these at this time.

other supplements

Melatonin: hormone in the body that is thought to promote sleep. It also has antioxidant properties. Melatonin declines with age.

Pheromones (Feliway), Zylkene, Anxitane (L-theanine) may help reduce anxiety in cats that are disoriented and may promote sleep.

Therapeutic diets

Therapeutic diets containing antioxidants and fish oils have been shown to help cat dementia.

Feline Mature adult Hill’s Pet Nutrition
Purina Pro Plan Age 7+
Hills prescription diet j/d with fish oil for osteroarthritis

Diets that reduce anxiety may also help with cat dementia

RC Calm diets
Hill’s urinary support

Medications

Selegiline: licensed to treat dementia in dogs. Like the dietary suplements, it aims to reduce the production of free radicals. Selegiline stimulates the production of enzymes that eliminate free radicals.

Anxiolytics: Prozac, gabapentin and clonazepam are used to treat dementia by reducing anxiety.

boxes as enrichment for cats — Boxes can be source of enrichment for senior cats.

If you feel there has been a significant change in your cat’s behaviors, keep a journal or log and make sure to mention it at her next senior exam. Start the conversation with your vet about cat dementia and how to manage it!

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Cats and Pumpkin

Posted on October 31, 2021 by felinepurrspective_u3q4o6

It’s that spooky time of year where black cats and pumpkins are all the rage. But did you know that many cats dine on pumpkin year round? Why add pumpkin to your cat’s diet? Does it work?

pumpkin and cats

Pumpkin is a popular way to add fiber to a cat’s diet. Fiber can be used to manage diarrhea, constipation, diabetes, satiety, and hairballs.
Fresh pumpkin is said to have about 3 g of dietary fiber per cup while canned pumpkin can have up to 7 grams per cup.

What is fiber?

The story about fiber is complex so I will just say that fiber is substances in food that cannot be digested by the enzymes in the small intestines. Fiber arrives in the large intestine undigested and unchanged.

Fiber can be soluble in water or not (insoluble).

Soluble fibers

Some soluble fibers form a gel in the intestines that slows digestion of carbohydrates, keeping blood sugar levels steady.
This gel may also block fat that would otherwise be digested.
Other soluble fibers ferment in the large intestine, forming the short chain fatty acids (SCFA) that are part of the cross-talk between the intestinal microbiome and the brain.

Insoluble fibers can pass through the GI tract intact and function to “bulk up” stool and help waste move through the gut.

THE TAKEWAY: It important to have the right amount of the right type of fiber.

Too much fermentable fiber can result in excess gas and gastrointestinal discomfort.
not enough insoluble fiber may result in diarrhea.

Fiber and carnivores

We tend to think of plants when talking about fiber. But our cats are obligate carnivores, meaning they mainly eat meat. Do they need fiber?

“animal fiber”

A wild cat will eat the entire mouse – fur, bone, cartilage, gut content, tendons, ligaments. These indigestible parts act as fiber – bulking up stool and helping waste pass through the intestines. Even the chitin in the wings of that grasshopper can function as fiber. Some of these materials ferment in the large intestine forming SCFA that allow the microbiome in the gut to talk to the brain.

A study looking at “animal fiber” compared a diet of whole rabbits (fur and all) versus supplemented beef for captive cheetahs. The cheetahs eating the whole rabbits had more SCFA in their stool than those cheetahs eating supplemented beef. The stools of the rabbit-fed cheetahs were also bulkier due to the “animal fiber”.

We don’t feed our cats whole rabbits – plant fiber is more easily sourced so commercial cat food includes these. Research has shown that feeding our cats moderate amounts of fermentable fiber such as beet pulp helps feed the intestinal microbiome without a lot of gas and bulky stool.

“Differences in fiber type and amount likely result in many of the gastrointestinal issues that pet owners see that vary with diet – they can often explain a pet who has poor stool quality on one diet but perfect stool on another. Too much or too little or the wrong mixture of fiber is a much more likely reason for a pet to not do well on a specific diet than a food allergy…” (from Fiber Frustrations, Cummings Veterinary Medical Center at Tufts University)

Back to Pumpkin and cats…

Pumpkin has both soluble and insoluble fiber. One tablespoon of canned pumpkin contains about 0.1 g of soluble fiber and 0.4 g of insoluble fiber. By comparison, 1 teaspoon of metamucil ( psyllium) provides 10 times as much fiber: 2 grams of soluble fiber and 3 grams of soluble fiber.

While pumpkin is safe for most cats, you may have to give a lot of pumpkin to match the level of fiber in say, one of the veterinary therapeutic diets. There are no real guidelines to supplementing fiber in commercial cat diets so talk to your vet if you feel that your cat needs fiber to manage diarrhea, constipation, or hairballs. Your vet can recommend a diet or supplement with the appropriate type and amount of fiber.

If you decide to supplement your cat’s diet with pumpkin, be sure to choose canned pumpkin and not pumpkin pie mix. While pumpkin and cats are a safe combination, the sugar and spices in pumpkin pie mix are not good for your kitty.

The nutritionists at Cummings Veterinary Medical Center (Tufts University) recommend that …“If supplemented, fiber should always be given gradually over a few days to weeks until the stool reaches the desired composition or other desired benefit is reached (or it becomes clear that it is not helping).”

Happy Halloween!

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Treat the whole cat for a better quality of life

Posted on October 24, 2021 by felinepurrspective_u3q4o6

Elevated feeding station for a cat — Athena’s microchip feeder raised up on a platform.

My oldest cat, Athena, is 16 1/2 years old now. She was diagnosed with Chronic Kidney Disease (CKD) and osteoarthritis a few years ago.

Signs of CKD

Weight loss
Poor appetite
Lethargy
Increased thirst
Increased urination
Vomiting

Kidney disease can result in reduced appetite and weight loss due to underlying nausea. As the kidneys become less efficient, cats drink more and more water to compensate for the reduced filtration, but they just can’t drink enough. One side effect of this draw on the body water by the kidneys can be constipation. And constipation can also result in reduced appetite.

Athena was losing weight, seemed depressed, did not want to eat and was not very active. Her quality of life seemed to be declining.

My vet recommended:

a laxative
an appetite stimulant

I added the laxative to Athena’s moist cat food. When she ate things were good.

If she did not eat:

she did not get the laxative >>she would become constipated >> she would not eat even with the appetite stimulant.

I felt we were trapped in a downward spiral.

It is important to treat the whole cat when managing an older cat with multiple disorders.

treat the whole cat

medical treatment

In addition to kidney disease, Athena also suffers from arthritis. Having been a fairly active cat who went on daily walks, it was disheartening to see her decline her walk and stay at home. Her gait became stiffer, in spite of a heated bed and daily exercise in the form of play.

So, I wondered, what if the pain due to arthritis was a bigger player than we thought?

What if stiff and painful>>not moving as much>> bowels don’t move as well>> constipation >>drop in appetite?

I asked my vet “What if we treat the arthritis pain?” Athena moved fairly well in the vet clinic but x-rays showed quite a bit of arthritis in one hip and one knee. The vet prescribed gabapentin twice daily for Athena.

dietary changes

To reduce the constipation, Athena needed more fluid and a laxative. I decided to try a hydration supplement, Purina Hydracare, and added the laxative to the Hydracare. Fortunately, she liked the Hydracare so down went the laxative in a little Hydracare! This way I knew she got the laxative without stressing about her eating her entire meal.

environmental changes

Because her hips are painful, it occurred to me that “maybe crouching down is painful” so I elevated the feeding station. While she eats, she puts weight on her back legs, helping strengthen her back legs, which are most likely weaker from her previous lack of activity.

eureka!

Athena has responded well to the gabapentin – it does affect her balance a bit but she has become more active again and we have resumed our daily walks.
Increased activity combined with the hydration supplement and laxative seem to have have eliminated the constipation.
Athena accepted the elevated feeding station right away – I guess being more comfortable encourages her to eat more.

the takeaway

It is important to “treat the whole cat”. Treating Athena’s arthritis pain seems to have been a game changer. Although reduced appetite and constipation often accompanies kidney disease, reducing the pain of arthritis has balanced this out, increasing mobility and appetite.

She is still an old cat but her quality of life has improved dramatically with these changes.

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