This week we are focusing more on the clinical side of being a vet and since I’m a crazy cat lady, I thought I would write about some of the most common problems you will pick up when you are examining cats in the UK. I’m curious to hear if this is also what you find back home?
In the UK, many cats will have a long lifespan and it’s not usual to see cats that are over the age of 16 years old. That means we see problems you may not consider as relevant if you are used to a younger cat population.
Chronic Kidney Disease
Ok so you knew this one was coming, right?… CKD will invariably be found in cats above a certain age and clients will often volunteer relevant information when you ask them about the health of their old cat. “Oh she drinks LOADS of water, she has no problems with that”, they sometimes say produly. But you know better and immediately start to wonder if they have CKD. Many owners are open to testing and treating it and it’s one of those that is best to pick up before they have a crisis. Most practices will have an internal lab that allows you to check serum biochemistry, often including phosphorus levels. Urinalysis is also widely available and many practices have blood pressure reading equipment. This means you can usually appropriately stage the cat and follow IRIS guidelines for their treatment. Diet is widely available, as well as medication such as ACE inhibitors, telmisartan (which now also holds a licence for lowering blood pressure) and phosphate binders.
This is a very relevant problem that you will also encounter in younger cats, as it seems to be more prevalent than previously thought, even in the absence of minimal radiological changes. However, in older cats this may be responsible for house soiling, weight loss and reduced food intake (no one likes to be in pain!!!). Many owners will say that their cats are “getting older” and don’t necessarily see it as something that needs addressed, however we now have plenty of tools to help cats live more comfortable lives. It is also important to ask questions about their cat’s behaviour, rather than closed questions such as “is he in pain?”. You are more likely to understand the changes and implications of the disease by asking “does he still jump to the kitchen counter, or does he seem hesitant?”. There are some questionnaires you may be able to hand out to the owners. NSAIDs are the typical medical choice, with robenacoxib being licensed for long-term use in cats. However, supplementation and diet are also widely available and used. Pain control can also be achieved using other drugs, such as gabapentin and opioids, to mention a few.
If you see enough older cats, you will see plenty of them with hyperthyroidism. They often present with very typical clinical signs and you will investigate them for kidney disease at the same time, although you may have more unusual presentations. Hyperthyroidism may be treated differently from what you expect, as radioactive iodine treatment is available and is the gold standard treatment. It is only available through certain referral centres and still expensive, so not every owner takes it, however you should explain to them that it is available so that they can make an informed decision about how they want to treat their cat. Medication is widely available for medical management of hyperthyroidism, with many cats willingly taking liquid medication. Surgery is also commonly performed in first opinion practice. And finally, iodine-free diet is also available, although not every cat is a good candidate!
This will often come hand in hand either with CKD or hyperthyroidism. However, once in a while you pick up on a suddenly blind cat to find out that there is no other disease process going on. Many practices will have the equipment for you to measure blood pressure, although you want to do it when the patient is relaxed and you may, therefore, require a second appointment to confirm your results. Medication is widely available to control hypertension and plenty is licensed for use in cats.
Cognitive dysfunction syndrome (aka feline Alzheimer’s)
When you start to see several old cats, you will also start to see several old cats with neurological changes. Cognitive dysfunction syndrome is more widely recognised, but may still be something that the owners see as “normal” for their aging cat and you often need to give them an owner questionnaire that they can fill in and start to realise that what their cat is doing isn’t normal. In many cases, it will be about the cat meowing like crazy in the middle of the night. However, there may be other cases where more changes are present, such as the cat looking “lost” and confused or forgetting where the litter tray is. There isn’t any medication licensed for cats, but some of the drugs available for dogs are used off-license and selegiline is also used by some practitioners for this purpose. Diet support and nutraceuticals are easily available and often used.
Do you see all of these in the cats you are responsible for?
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