Care of the Ageing Cat
The ageing cat………..
Domestic cats can enjoy a long life span, sometimes into their 20s. As our dear moggies age there are a few things that owners should monitor to allow early detection of any disease processes that are common, and often treatable, in the elderly cat.
Changes such as an increase or decrease in appetite, an increase in thirst, frequent diarrhoea or vomiting, weight loss, changes in behaviour, disturbances in vision or mobility, should prompt a visit to your vet for a clinical examination of your cat.
Osteoarthritis is a form of arthritis where the cartilage within a joint that prevents bone rubbing on bone is worn away resulting in discomfort. This process can either be primary, where there is no previous injury and the process happens for unknown reasons, or secondary as the result of previous injury. Obesity in cats will exacerbate any arthritis.
Whilst we have long been aware that our canine friends can suffer from painful osteoarthritis causing them to be stiff upon rising, have difficulty jumping into the car and be slower at walks, cats remain under-diagnosed and tend instead to suffer in silence. It may shock you to know that a recent study (Hardie et al, 2002) demonstrated 90% of cats in their study over 12 years of age had evidence of degenerative joint disease. Whilst symptoms are quite obvious in dogs, cats are not taken for walks and will down regulate their own exercise to cope with the degree of discomfort. Cats will rarely vocalize pain.
Symptoms that cats may display:
* Reduced frequency going ouside
* No longer jumping up onto favourite places
* Sleeping in new, easier to reach locations
* Slower going up stairs
* Reduction in play time
* Struggling to use the cat flap
* Missing the litter tray/not using litter tray- often it is too painful to squat and fit in the tray
* Matted coat as grooming becomes too difficult
* Over grooming painful joints
* Less keen to interact with the family- cats with pain can start to resist being picked up or will react if a painful part of the body is petted
* Possibly lameness
There is help available. A clinical examination carried out by your vet may indicate a painful joint or joints. It may be helpful to take radiographs (xrays) in order to diagnose the condition. Treatment can then be discussed with your veterinary surgeon. With treatment we would expect to see an improvement in your cat’s quality of life.
Treatments include the use of non steroidal anti-inflammatories, such as cat Metacam. Metacam is an anti-inflammatory licensed for chronic pain in cats. (Please note that dog and cat strengths of Metacam are very different so only use Metacam as specifically prescribed by your vet for that pet). Often with older cats we may see multiple problems at once, such as concurrent kidney or liver disease. Your vet will be able to make a risk assessment based on discussions with yourself. Blood tests may be helpful to check kidney function etc.
Neutraceuticals in the form of chondroitin sulphate and glucosamine can also be very helpful. These components can help to improve the condition of the joint cartilage and fluid and so help with comfort levels. Combination therapy is often the most successful and can help reduce the reliance on non steroidal anti-inflammatories. There are various different joint supplements available and it is advisable to discuss the options available with your vet.
Diet also needs to be carefully considered, being over weight will increase the load placed on the joints causing a more rapid deterioration. We can help compile a weight loss plan.
Acupuncture is also available as a treatment for osteoarthritis, either in addition to more traditional therapies when adequate pain relief has not been achieved, or when use of medications is difficult due to other medical conditions.
Hyperthyroidism is a very common condition in older cats involving over-production of thyroid hormones by the thyroid glands. The thyroid glands are located in the neck and when enlarged can often be palpated, this is called a goitre.
Hyperthyroidism is treatable, with the majority of cases showing a resolution of clinical signs and attaining a good quality of life as long as treatment is continued.
Thyroid hormones drive metabolic rate and as a result hyperthyroidism can produce some quite dramatic symptoms.
Symptoms of hyperthyroidism
* Increased appetite
* Weight loss and loss of condition in general
* Increase thirst
* Matted coat
* Increased restlessness, irritability and other behavioural changes
* Vomiting and diarrhoea
* Panting when hot/stressed
* Rapid heart rate
* Goitre (enlarged thyroid) palpable on neck
* Advanced cases may show a loss of appetite and generalized weakness as a result of toxicity on the body from thyroid hormones
The thyroid hormone has an affect on all organs in the body and can contribute to the development of heart failure and high blood pressure. These conditions may need to be treated along side of the hyperthyroidism and should be monitored for.
Diagnosis will require a clinical examination by your veterinary surgeon and blood tests to test the level of thyroid hormone in the blood. Kidney and liver parameters will also be checked on these blood tests. The liver will often show some affect of the hyperthyroidism and this will be monitored on further blood tests. Kidney disease, whilst not overtly caused by the hyperthyroidism can be contributed to if high blood pressure has resulted, and will often occur alongside hyperthyroidism. The increase blood supply to the kidney as a result of the overactive thyroid can result in kidney disease being masked on blood tests. As treatment for the hyperthyroid condition begins, a subsequent deterioration in kidney readings may be noted on further blood tests. Sometimes this will require some careful balancing of the two conditions, depending on which is causing the most problems.
Once hyperthyroidism is diagnosed, treatment and any additional problems that will need treating alongside will be discussed by your vet. The most common form of treatment involves oral medication with either Felimazole or Vidalta. This treatment will be required life long. A starting dose will be decided upon and then adjusted based on follow up blood tests. The tablets are small in size and most cats will tolerate treatment without much fuss. The fact that the medication is administered orally also allows flexibility in treatment depending on what other conditions we encounter along the way. A hyperthyroid cat on medication should restore its body weight and a more normal appetite. Its coat and behaviour should resort back to the cat you knew previously!
Another treatment option is surgical removal of one or both thyroid glands. This is a procedure with potential complications that your vet will discuss with you, but if life long oral medication is not an option this procedure can possibly provide a cure. Unfortunately thyroid tissue can exist as ectopic tissue in addition to the two glands, this tissue is not surgically accessible and if it is present hyperthyroidism can develop again despite thyroid glands having been removed. Before any surgery oral medication will be necessary to stabilize the thyroid to reduce the risks of the anaesthetic and to check the effect of treatment on the kidneys.
The final treatment is the use of radioactive iodine which can actually cure the cat of the condition. Whilst it is a safe treatment for the cat, it is only available at specialist centres and the cat would have to remain there hospitalised for 6 weeks, until the radiation falls to acceptable levels. All these treatments options can be discussed with your vet as necessary.
Chronic Renal Failure
Chronic renal failure is the term used to describe the progressive loss of kidney function seen in older cats. The failure is a result of irreparable damage to the kidney, the cause of which is often not known. This damage reduces the ability of the kidneys to perform their important roles in maintaining normal body function. The kidney are responsible for filtering blood to remove toxins that build up as a result of the body’s metabolism, and controlling the body’s water and electrolyte balances. In this process urine is produced to excrete toxins and excess water, and urine can also be concentrated to retain water and prevent dehydration. As the kidney’s function declines the ability to concentrate urine is lost, and the cat will drink more to compensate, but will quite often be in a dehydrated condition. Loss of control of electrolyte balance can lead to a low potassium which can cause weakness and loss of appetite. A build up of toxins in the blood will result in nausea, vomiting, ulceration in the mouth and sometimes gastrointestinal tract.
The kidneys are also responsible for controlling blood pressure and red blood cell production, as a consequence anaemia and high blood pressure are often seen with kidney disease.
Chronic renal failure is one of the commonest conditions in the older cat. It can affect cats at any age but is common in middle to older age cats. The disease progression varies between individuals, some cats can lead a good quality of life for years as their kidney function deteriorates slowly, others sadly deteriorate more rapidly and euthanasia becomes necessary. Appropriate treatment and support can help to improve quality of life and prolong life as it can help to slow the disease process.
The symptoms of chronic renal failure often appear quite slowly. Symptoms most commonly reported are; drinking more water and producing more urine. Weight loss, vomiting and a decreased appetite are also often noted. A matted coat, bad breath, ulcers in the mouth, weakness and lethargy may also be noticed.
If your cat is displaying any of these symptoms we recommend an appointment with your vet to enable a clinical examination and history to be taken. Diagnosis is made from taking blood tests and urine samples.
Sadly there is no cure for kidney failure but treatments are available to try to slow the progression of renal disease and to improve and maintain quality of life.
The most important component of treatment is use of a special veterinary prescription kidney diet. These diets have controlled levels of protein and phosphate, this can have a protective effect on the kidneys by reducing their work load and slowing deterioration. The veterinary diets are carefully formulated to ensure that all nutritional requirements are met, and whilst protein is limited to a safe level, it is important that protein is not too low as this would result in weight loss.
Other treatments are aimed at controlling the side-effects and symptoms of chronic renal failure.
Dehydration is frequently present and in severe cases the cat may benefit from a stay in hospital on a drip. Fluids can also be delivered by subcutaneous injection.
Access to water is very important. Water intake can be increased by using wet kidney foods, and by placing multiple water bowls around the house. Cats particularly like running water, talk to us about getting a water fountain to help your cat drink more.
Often cats with chronic renal failure will have a raised blood pressure (hypertension). This can cause further deterioration of the kidney function with potential for leakage of protein into urine, and also have a detrimental effect on the heart and small blood vessels. Bleeding at the back of eye is a common side- effect of hypertension and can cause blindness. Blood pressure can be easily measured in cats and is an important part of monitoring a cat with chronic renal failure. Treatments that help lower blood pressure include medications like fortekor and istin.
Potassium will be monitored on blood tests and supplementation may be necessary. Phosphate will also be monitored, kidney diets help to control phosphate but additional help may be necessary in the form of phosphate binders.
Anaemia can also be present and will also be monitored on blood tests, use of anabolic steroid injections can help to stabilise the anaemia. These injections are often combined with Vitamin B12, a vitamin that is often low because it is excreted in urine. These injections can act as ‘pick me ups’ and they can be repeated every 3- 4 weeks.