Hello. Now, this webinar we're gonna be talking about old cats with behavioural changes. And they're not uncommon at all.
I'm gonna talk through a case and think about this cat with her behavioural changes, and then we're gonna focus on feline osteoarthritis. In the 2nd 1, 2nd of these meetings, which I think is June, oh, I wrote it down. July 10th, I think, but let's double check that.
We're going to be picking up the same case, but we're going to be looking more focused on her dementia side. And then we're gonna pull it, pull it together with, old age, geriatric clinics. And then we're going to finish off with her treatment.
So you're gonna have to remember the case until then. And here's the case. This is Sally, 16 years old when she came to me, and wanted to have aged a lot in the last 2 years.
She'd lost quite a lot of weight, but it had been very slow. It had been over 2 years. So I was concerned, but they said, really, you know, she's just kind of getting old.
She'd stopped grooming as you could see. She lived with a Labrador who normally washed her face, hence he can see that her face is a mess. She has been urinating, around the house, so she's got periura.
Is still defecating in the box, which is one thing, and she's crying loudly at night. And when I asked the owners what sort of crying, I'll see if I can do the same impression they gave me. It's gonna upset my cats.
Sorry cats. She went, she was going all quiet at night, and then she'd go. And yeah, oddly enough, yeah, it would wake them up and she'd go, oh, you're awake, you know, and we play now.
Clinical exam, you can see she's thin, ill-ke, a little bit dehydrated. She's got a fast heart rate with a murmur and a gallop. So, murmurs about, 2 to 3, depending where you were.
She's got a bit of a, a, a, a thyroid slip on the left. And just looking at her, you can see she's got arthritis. Look, she's got a hunched back, her tail's at an odd angle.
So you can see she's got arthritis in her spine. Possibly her hips as well. You could see her knees looked to actually be bony, swollen and her elbows were really stiff as well.
So the problem list, she's got periura. We've put, I put the heart things together, the altered behaviour together. So the, inappropriate, sorry, not supposed to call it inappropriate urination.
I slipped into it. The behaviourists tell us we shouldn't do that cause it's not inappropriate for the cat. It's only for the owners.
So we're supposed to call it house soiling urination, or peruria. And she's got arthritis. So what are the major differentials for the, for the 1st 3?
We know the arthritis is arthritis and that's what we're gonna focus on, but we need to paint the whole picture of little Sally. So if we're thinking about periuria, then certainly behavioural neurological things are right up there. So when you see a cat presented like this, we're thinking of this, so dementia.
Cognitive dysfunction syndrome, the name for it, that dementia makes so much more sense. Is we're gonna talk about next time, hyperthyroidism, absolutely, hypertension, which, of course, could be due to, hyperthyroidism, chronic kidney disease, or, diabetes really are the main ones for, for hypertension or, Oh, hyperallosterinism, which we're seeing more and more frequently too. It could be that it's actually lower urinary tract problems and it's inflammation of the bladder.
If we look at this graph at the top, look at the cat, sorry, look at the, the maroon colour. This is what we're seeing with, older cats. This is cats of more than 10.
Most cases are a UTI. Why have they got a UTI? Well, it's because they've got chronic kidney disease, diabetes mellitus, or hyperthyroidism, so it comes back to those three again.
Or that they've got polydipsia, polyuria. And that's why they're not being able to, the, the urgency. They've got a very full bladder.
They wake up, have good sleep, bladder feels really full, but they, you know, they need to get to the litter box too quickly and, and they're not able to do that. And that's the same three diseases. Or musculoskeletal problems, so arthritis.
And certainly, if you've got a combination of, PUPD. So you desperately need a pee and you've got arthritis, that is gonna be hard to to to deal with together. The cardiac stuff, we really don't see primary heart disease in 16 year old cats.
It's usually killed them before then if it's going to. So it's gonna be secondary heart disease, and it's secondary to the diseases we're already talking about. So hyperthyroidism, diabetes, chronic kidney disease, and hypertension.
And then the altered behaviour, hypertension, right up there, I've got to think about that all the time and say probably associated with the diseases we're already talking about. Need to think about degenerative disorders, so dementia, deafness, absolutely. If it's cancer, it's gonna be a slow growing meningioma, infection.
I see more toxoplasmosis in elderly cats that are presented to me than than you would expect. And I think that's because I'm always looking at the retina to see if there's any signs of high blood pressure. And if I see any retinal changes at all, sometimes it can be tricky to tell between hypertension and toxoplasmosis, in which case, treat for the high blood pressure.
You're gonna test the blood pressure anyway. If it doesn't resolve, then let's think it's toxo and treat for that. I had one little cat.
She had had signs of dementia for 3 months. And when I was asking her history, she was periuria, she was showing periuria. But the owner commented that sometimes it can smell a bit strongly.
And I thought, that's a bit odd. So we cultured her urine when we did her workup, and she had an E. Coli UTI.
Three days of amoxicla and she no longer had dementia. So that is an important thing to to think about because. E.
Coli, UTIs can cause signs of dementia. You see it in elderly people in nursing homes. Elderly ladies particularly put men too, so it's one to remember.
Metabolic encephalopathy usually gonna be hyperthyroidism and then pain as particularly associated with arthritis. And this is what we're gonna really focus on. But let's just not forget the the social environmental causes.
Ah, I love that picture. And so it could be attention seeking, it could be inadvertent, owner reinforcement. You know, you, if they're a cat that likes to eat at night and you start feeding them at night, and then they're gonna start wanting more food at night.
So, yep, that's definitely something that could happen. Frustration and boredom don't happen so much in older cats, but they can, distress or anxiety, change their environment is, is a common, common cause. And separation related problems, yep, we can see that and obviously sleep related problems if you're up all night yowling, you, you're not gonna get enough sleep.
So let's keep all of those things in our mind while we now think about arthritis. I think it's interesting to look at this data that we collected. So I know it's a bit small, I apologies for that.
. We asked Mm, I think it was about 2000 owners, . What, yes, it was, 2000 owners, what were the chronic diseases that cats were living with? And you can see 40% of them said arthritis.
Now we know arthritis is much more common than 40%, but. It shows that owners can recognise this. And if we give them better guidance, they can really not recognise this.
And this was more common than dental disease. If we ask the same question of that. They put dental disease first, then kidneys, hyperthyroidism, then they put arthritis.
So it's interesting that the owners and the vet list are are different. So let's think about different types of arthritis. Well, some people would say that ventral spondylosis is what I was brought up calling this.
I find it hard to say spondylosis to 4 months. . It's not a, a synovial joint, so it's not true.
And initially people thought, well, it's very, very common in old cats, over 80%. Not a cause of problem. But then more data started coming through.
It certainly is going to contribute to stiffness because it stops the spine moving. But is it painful? And then I really like this study came out about 10 years ago, and they showed the cats that had spondylosis deformances, poorer quality of, of life.
They did show signs of being uncomfortable. They didn't like being petted. They didn't want their back touched.
I have chronic bad back, and I can tell you, I don't like people touching my back. People go in for the hug and the big backpack. Oh, that's so painful.
And these cats, not surprisingly, can be aggressive, and I tell you I've shouted at the people who've tried to hug me too tight. So, yes, spondylosis to formances can cause significant problems to the cats. And what about true OA?
Well, the interesting thing is, it starts when they're very young. At 25% of cats less than a year have got OA in at least one joint. So it is very common.
All, all cats overall, it's about 30%, but it's particularly in older cats, over 90%, basically 100% of cats. If there are more than 12, they've got arthritis somewhere. Though it's common joints to be affected, stifles, elbows, and hips.
But don't forget tarsi and carpi and the studies that gave us stifles, elbows and hips we're only looking at. Radiographs that were chests and abdomens for other reasons. When people have actively looked and included the the the hands or sorry paws, then they have found more problems in the carpet and tarsi.
What is interesting, obviously, certain breeds are affected, particularly my, my beloved Maine Coons, but, Persians, Siamese, etc. All of those, either hips and or knees. And then Scottish folds are, of course, an aberration.
You will find some people say, Oh, I've, I've got a line of Scottish folds that don't get all the horrible arthritis all over the whole body, particularly in their feet. The line. There is no way that if you get folded ears, you will not get all the arthritis and the pain that goes with it.
What is interesting is there does appear to be an association with chronic kidney disease. If you've got arthritis, you're likely to get chronic kidney disease. If you've got chronic kidney disease, you're likely to have arthritis.
OK, the bugs more common in older cats, but it's more than that. Maybe, we've got, the inflammation that's going on in the joints is leading to, antibody production that is then I mean complex in the kidneys or is it inflammatory cytokines from these joints? We don't know that yet, but Always remember to check the kidneys before starting treatment with these cats.
It isn't the same condition as in dogs. It's much more idiopathic. You know, we don't have anywhere near as much of the, the genetic base.
So I've already mentioned, we do see genetics in certain breeds, but most cats, it just seems to be slow degeneration, low grade traumas, etc. Diet is a big player, and certainly fat cats have got a, a much bigger chance. We do see it associated with trauma.
The picture in the middle is from a cat called Tripod. He had lost his other back leg. And you can see that this, stifle has got, horrible arthritis, really, really badly through the whole middle of that joint.
It always mean blood into the joint, I think. Infection, that would be mycoplasma, more typically, and certainly, we can see the, usually the mycoplasma foetus. So that's the one that would typically be in that the, the retropharynx can go into the lungs and it can get into the blood that can affect joints.
Typically in kittens as joint deal, but you, I've seen it in, in occasional of a normal age cats, adult cats. Lifestyle, obviously, if you've got a traumatic kind of lifestyle, it's gonna be more of a problem. Here's one of my beloved cats.
This was my, my Mortla. He was the, the feline love of my life. I know I've got two of his descendants now, and they're absolutely gorgeous.
And to be honest, McDuff, the, the red boy, is, he's getting there to compete with Mort, but, Mort was such a special boy. He got me through when my back went. He looked after me the whole time.
He just lay there with his head on my shoulder and his paw across and And when I had spasms and things, and, he would just purr louder. And you do know that the purring of a cat between I think 25 and 150 hertz, that will actually help bones heal. That's been actually shown in the lab.
So purring is good. Purring does help healing. Well, I got him cause he came to our, our clinic at a year old.
These are his hips at the top. And you can see he's got hideous, hip dysplasia and medial patella luxation. And so he had bilateral tibial crest transpositions.
But these are his hips by the age of 4. And he, you can see here he is, age 17. He, he holds his legs in a very stiff way.
I always walked with his back hunched up, trying to put as much weight forward as possible. As my, my, my beloved boy, when he's younger and then at the top is him at 18 and he would always find something to put between his back legs like that when he was sleeping and it, it put its tail up. It was the most ridiculous thing.
But that was obviously what took the pain out of his legs, that way he could be comfortable. You can see in the picture at the bottom, he's got his elbows are poking out the way, and then his carpie are, are turning in like that. That's a, a very much typical old cat stance, that the, the carpie twist out in response to the, elbow arthritis.
I told you he's my beloved boy, and. I had his skeleton preserved. And there he is in pride of place in the the lounge.
I know. You probably think I'm a bit strange, but I also know some of you are gonna go, Ooh, that's cool, isn't it? And you've got to admit, he looks stunning.
And I love the fact that they've positioned him with his back straight. If I was able to, if you can, with your screen, hone down and look at his elbows and look at his stifles, his stifles, the, the telly actually had rotted away to just sludge, and you can see just how bad the arthritis was, and on his carpe and cari as well. So, in, in, in cats is different to dogs.
They, it tends to be subtle, it's bilateral. And Because you've got to buy out, even if it's not quite symmetrical, it's, you know, you don't hop if you're affected on both sides, and it, it comes on more slowly, so owners often miss it. Studies show you you don't see that much of a lameness.
You don't see joint pain, you don't see soft swollen joints, or you, you certainly can see altered range of movement but not so much. It's it's gonna be pretty pretty late on. What you do see, oh this is a picture from Andy, this is the ninja cat, which I think's brilliant.
Reduced ability to jump, reluctance to jump. So things that they used to jump on comfortably before you see them just. More of a butt wriggle thinking about it.
If there's a chair that they can get onto to get them onto the table that they want to get onto, then they're gonna take that alternate route. That's the sort of thing. So they just can't jump as high, they're not, jumping that's as strongly.
Reduce playing, reduce grooming. So they often get unmatted, got matted bits, particularly over their hips. It's very difficult to twist around to groom over your hips if you've got, any degree of arthritis in your hips or your back.
And obviously, problem with the litter box, because if you, you can't move your limbs properly, then that's gonna make it tricky, particularly if the litter box isn't big enough. So that can lead to to house soiling, can lead to constipation. And say, poor posturing when urinating, defecating is, is common.
So they, they'll get into the litter box sometimes because they can't get their bum down. They end up pooping or peeing just outside the box. And if you've got an owner who brings the cat to you, and the thing is that they're either peeing or pooing beside the litter box.
Then first thing I'm gonna do is say, well OK, change the substrate, substrate into a a softer substrate if they're using something like the kibble, so use a sandy one instead, . And get a, you know, cut, cut out the box, so, you know, cut a little doorway, you know, step so that they can, they can get in and that usually so solves the problem perfectly. Other things are reduced aggression with reduced interaction with people or even aggression with people.
Jason at the top's got really bad arthritis, he's also blind, so he's defending the kennel from the rest of us. And definitely look at the toenails. We know as cats age they don't, that the tendon that retracts their their nails is nowhere near as good, so the nails drop down.
The nails also get firmer, the same way as peoples get firmer. So it's harder to wear them down. If you've got arthritis It is you can't, strap your nails to, to take the shells off.
So, with arthritis, you get these overgrown nails. Really important that owners check the feet. The old lady that owned Snowy was so upset that some of his toenails were ingrown.
She said, But why didn't he tell me? He was lame and all 4 ft, and that's why he couldn't. And then Poppy here again, really badly rown toenails, and that was a, a brilliant owner.
She just, Poppy had never liked her feet touched, so she didn't get her feet touched, but as an older cat that can become a problem. So I get the owners to listen for the clicking toenails. If they're hearing more clicking toenails, it's time to trim the trim them.
If they can do themselves, great. If not, then take them to the clinic and ask one of the VNs to do it. And reluctance to use the cat flap, well, that's not at all surprising.
If you think about how you're to twist your joints to get through a cat flap, it's not surprising that they'll quite often start urinating and or defecating on the, the, the mat just in front of the doormat. This was a, a report, Petra found this one for me, in the, the veterinarian. And what did they find most?
This is 80% of of this is the, what the vets think, and they knew it was ask about jumping. But if you ask what the owners thought it was actually that they were less active, less willing, willing to play, and then hesitant about jumping. So, you see, owners see a little bit different.
And, and that was the most common. So asking about the cat's activity is really important. And then this, this paper and amoto, .
Came up with these are the questions that are most important to, to ask. These, these are the ones that will correlate to the severity of the, the arthritis if you actually, so it's validated. So does it jump normally, jump up, jump down, climb the stairs, jump down the stairs?
Can it run? Can it chase? Can it move?
In other words. What can be very helpful, there are all sorts of questionnaires like this, lots, lots accessible. But get the owners to take a video because seeing the cat walk around the floor in the clinic is often just, it's not good enough.
This is just Zita's, questions that you couldn't use, any of the companies. And so you can see these little cartoons are, are really useful if you can get the owners to, to look at the cartoons, think about how their cats make these moves and behaviours, fill out the little questionnaire before they come in. So you can send this out when you send out their vaccine reminders.
And then they're already coming to you, ready to go, I think my cat's got arthritis. So, ask the questions. So you want to ask about mobility, activity, grooming, change of temperament.
So I indicate pain, all of those things. And you, you don't need to prove it by taking, radiographs. If you are anythingizing the cat for some other reason.
And radiographs could be useful to tell you how bad it is, but trial therapy is much more appropriate. And I'm not advocating that every cat goes onto meloxicam, but in this study, where they put all them in a group of cats on meloxicam, you can see there was a marked improvement at over 60%. And when you include marked improvement with moderate improvement, you get 75%.
So that is a lot of cats being an awful lot better. So therapy, management check, what can we do? Well.
Life lifestyle, if they are obese, like my beautiful old card you used to be a rather on the chunky side, he is getting his food in a feeding bowl, and what he's looking at is kibble that's fallen out of the ball. So that encourages the cats to move around more, which is good, increases their rate, just even 5 minutes twice a day, of play can make a huge difference. For example, the diabetes, let alone to, to, to fat burning.
So try to get them to move. If Increasing movement is not possible. Here is, is Mortlak, at 15.
He was lying on my, my chest one day when I was lying on the couch. And then he squeaked, rolled off, and then lay on the floor, and his back leg was, was tremoring. And so I got down to see what was wrong.
And his, his thigh, that was all, all the muscles were, were, were in, spasm. And so I gently massaged them for him. And initially, you know, he was looking at me going, Oh, that hurts.
And then it was like, oh, actually, that helps. So from then on, if he had a cramp, he would stagger to find me, roll over and go, Hey, you know, do your duty. So, massage can can.
Certainly help. The little girl is in at the bottom. She's on a heated bed and certainly warmth, particularly if you're in winter, in, anywhere that's cold, then providing warmth for cats when going out to work.
So it's remember these thing, remembering these things to say to owners. And this, if you had to do one single thing to help elderly cats, whether they've got arthritis or dementia, is raise up the food and water bowls. Because if you haven't got to bend down and put the pressure on your elbows, your neck, shoulders to eat and drink, you're much more likely to do both of them more frequently and eat, eat more, drink more.
Ideally, not placing them both side by side, as you can see with little blue Brinkman at the top, but you can see plastic tops, Tupper Tupperwares, works, a drink. Not expensive at all. And then my little Tia Nnek, just towards the end of her life, she started needing, the old lift up.
But the problem is she kept pushing the plate off the Tupperware. So I bought her a proper, raised, raised one. And you can see that Sarah Ellis bought one, a, a much fancier one for, for Bailey.
So raise up food and water. Make sure they can gain access to them. You want to keep things as much as possible on the level or make sure the cats have got stairs to get to where they want to get to.
What I would say, being, disabled myself, if you put me on a ramp, it changes the proper reception within my joints, and it's really unsettling. And I ramps are still there because I always want to remember to mention them. Looking at cats with arthritis, they really don't like ramps.
And that makes sense because you're changing the angle of the, the, the joints as they have to walk up or down that ramp, better to give them steps. That seems to be what they're much more comfortable with. Lots of, of bedding, but make sure it's not that can, can catch their, their claws.
So you need to make sure all of the key resources, so that the main ones. Somewhere to eat, somewhere to drink, litter box, beds, hiding, resting place, preferably high up, and then entry exit points or somewhere very safe to hike. It's a way to get away from something that's that that's upsetting them.
And a lot of cats don't want the the cat flap anymore. They'd much prefer a place of safety. I really should add scratching posts there because it is important to still offer them because they do often still want to try.
And I'll show you the the type I prefer. Now I've got lots of pictures in because I think it tells a a big story. So here's my, my beautiful mortlak, and this is the day before I had to put him to sleep.
I really shouldn't include these pictures because they just. It just broke my heart. And what you can see it on the bottom right handle, that's the picture in the middle.
Sorry, it's more. You can see black edge of a chair, so he could climb up onto the toilet seat, and then, which is to the left of the picture, and then on the shelf beside into the sink. He could do all of that himself, but he couldn't, he had just got to the point that it was too hard for him to jump down on the, this chair's got a rat and seat.
So it doesn't, he doesn't slip his paws. If it goes the other way, he slips. It's a very smart cat.
So what he's taken to doing was he would just get up there to, to drink from the tap and then shout for me to come and get it. Stuff. So, if owners have got cats that do drink from taps, it is important that they're, if they can't keep doing that, that they're offered another source of water.
If they're like running water, then, fountain can be a really good thing to do. But it's supplying them with water in what they prefer. A cheeky at the bottom, he had his big glass, jug, you know, pint, beer mug, and even when he came in for hyperthyroid treatment, he had his mug with him cause he wouldn't drink water, other than that.
Litter boxes, this is, this is a litter box, so it's big. You've got Maine Coons, you've got to be honest, they really need something the size of the bath, but that's my bath, . Actually, water.
The cats just sorts of funny just thinking about my cats. They drink their water. They're really messy with the water.
They play with it. And so it's in the bath. So I can't turn the bath into a litter box for them because then where I'm gonna put the water?
But yeah, you need a big litter box, preferably 1.5 times the length of the body. Hard to do with a Maine Coon.
But you can see, it's a big box, but it's low at the front. So that's easy to get in high at the back. So if they can't get their, their bottom down.
Shallow litter boxes, like, it's really shallow, it's just a tray. That can be a good way to go. And the one at the top, yeah, that's a litter box from hell.
Nice they've given the steps up, but how's the cat gonna get out? And then, steps, thinking about key resources. So, key resource in our house is the big bed.
It's my, my husband's bed. And there's more like at 14, he was finding it hard to get up onto the high bed. And so we put his toy box there, and that enabled him to get up.
But as he got to 18, he needed a ramp that because, sorry, the bigger steps, because it, the box wasn't enough. But he then fell through that. It was horrible.
I, I was in bed at the time, and, oh, it was so sore. So I phoned my friend John, who came straight down with these cop bodge together things we can see them put together. And then, about a week later, he produced this beautiful, bespoke set of steps, each step being big enough for a cat to sit on, and it goes under the top, the step above, so it can't slip through.
Also think about lights. I know you think cats can see in the dark as they get older. They don't seem to be able to do it and actually offering night lights can be quite helpful.
Stops them falling. And then these are just, pictures. My friend John's house with his cats, so you can see lots of great stuff there.
Different, ramps that different people have set up in, in their houses, and steps. So it's getting people to, to, to think that this Can it help them get, so if you look at the picture at the bottom with John Purvis written underneath, that was Nimbo's favourite lookout post. That's where he likes to watch, but he stopped being able to get there, so he's got these steps up.
Resting places Warm places. Soft bedding, maybe heated bedding. Here's Bailey at the top, sleeping with his, housemates.
That wasn't enough as he got older, and he's sitting by the fire, but it's not really comfortable for him, so his mum got him a fleece to be fire the fire. I know we're all. They they wrapped their tails around our hearts and we're lost.
Then somewhere to hide, really important that got somewhere to hide. And so I would question continued out outdoor access through a cat flap. We'll come back to that in a second.
Some playing. They often do still want to play, but they can't play with heavy toys. They need little toys.
So there are lines of toys that are designed for cats with arthritis, preferably not live ones, as we've got at the bottom, but I just funny pictures for you. And then at the top on the right, you've got, a mort. And this is actually, it's a toy box I can put the poor end play with the ball inside.
It's also a horizontal scratching post. Which he did start using, and then she was started using, and it's now beside me. And, Muk Duff likes the, the, the, the latch, the, the horizontal box.
He likes the up high one too, but it gives them options. And when you become an arthritic old cat, these horizontal scratching boxes, they're just filled with corrugated card, can be very, very good. And then outdoor access.
We've got Hobie at the top, top left, and he's 26. Sara Canes, beautiful old boy. He still liked to go out his promenade, every evening, but he was scared to go out on his own, so Sarah, one of the girls, would have to go out with and sit with him for 5 minutes.
That's all it took. And then he'd want to go in. More like in the middle, like to go out, but, he went out on a lead.
And then the the pictures of the middle and top. This is a friend of mine who has now passed, this is her cat's garden and you can see it's it's they've got a a ledge under . Metal that stopped other cats coming in and you got the steps going up to it.
What other, other things around in the pictures. So that's all the environmental stuff. And all of the environmental stuff makes a huge difference.
So it is important that you mention these things, handouts, that sort of thing that really, are gonna help. And owners love it when you tell them things like this, you know, Raise up the food and water bowl. They go, Oh, I'd never thought of that.
And, you know, it's good. And it's, it's so effective. What about diet studies?
Well, we've got 2 here. There, there are others. So the first one, this is a royal cannon product.
And, Duncan Laces did a a brilliant study. He even had activity monitors on the cats to, to, to show that they could move around more. And then hills at the bottom, and you can see that you've got significant improvement.
And the, a lot of the different companies now will do these combo, products, so kidney disease and, joint disease. So with an old cat that's got kidney disease and joints, it's perfect. And then this is another health study.
It, it just shows you all of the different goodies that they've put in to JD I do find it the most effective of the, the diets followed by the Royal Cannon one. And it's much more palatable than some of the hills ones. So both of these diets palatable palatable, which is good.
This was just a 2 month study, open label, and the owners, vaccination were asked, to try for 2 months and then feedback. And they'd improved mobility, that improved, signs of dementia even more, and we'll save that for next time. And then are there any medications that we could try?
Well, we've got the chondroprotectants, and there is more data coming through on this now. It's, it's not massive. I think the data is better for green lip muscle, which makes sense because it is much better for humans and it's, and for Almost looks like they've got the date of the dogs.
But with people looking at knee arthritis, green lip muscle is as effective as non-steroidals. So, that's pretty impressive. And you can see the, the different comments here.
Anatol, it's a particular way they extract the ring muscle. They believe that it gets, much purer, richer supply. We've got this study just using omega 3s which reduced some stiff stiffness, more interaction with owners and better jumping, so just using the omega 3s can make a significant difference.
. And you can see, so these are gonna be better for the early cases. They're not gonna help a really severe case, but in early cases, then, these are where it's gonna help. My preference, if you want me to state one, is for you move.
I have had a lot of success with that product, and it seems to be very palatable. So. But try others.
Feed me back the information. And then what about non-steroidals? Well, there's quite a few papers now, there's a, a series of them across there using particularly meloxicam.
And what they show is that with what they looked at is cats that had iris stage 1 or 2. And they had arthritis, and they put them on meloxicam. Who had the best quality of life, not surprisingly, as the ones on meloxicam, because it was, they were not painful, who lived longer.
It was also the ones treated with meloxicam, because, of course, the ones not treated. Their arthritis was actually what the owners could see, not their kidney disease, and they saw a cat that was inactive and painful, and so the cats end up being euthanized. So meloxicam is definitely gonna improve things a lot.
But you don't use standard doses, all right? You go 0.1 to 0.3 mg per kg, and then titrate down as far as you can.
So you're basically, if, if you think a standard dose would be 0.05 mg per kg, not using a loading dose. So I might, I always think in my head, 0.05, normally, 0.02 from my old cats.
One The thing I would say, that the study that showed the UPC can go up in some of the cases, and they had the, the cases of cats on meloxicam, got a median of 0.3, whereas the cat's not on meloxicam 0.1.
Now, if you think that the reference interval we want to do, we want to stay below 0.2, if they got kidney disease, 0.4.
As a general, that's, we say that the, the normal for cats is, is 0.4. So the kidney desiccates.
I want to go to 0.2. So what you must do with these cats, because I've already said that kidney disease is more common in cats with arthritis, you must check the bloods and the urine.
And then check the urine after a week or two. And if the urine, if the protein has gone up above 0.2, then stop the meloxicam.
Think of something else. We don't have much data for ASA, but, there are, there are the doses. What else I would say about the use of non-steroidals, say.
Titrate down and then care if they've got diseases that might cause, dehydrations, kidney disease, hyperthyroidism, diabetes, cause they all cause PUPD. If they've got heart disease, I'm a little bit twitchy, severe GI or liver disease. if they've got severe GI disease, no, don't, you're not gonna use this drug.
Severe liver disease, OK, you're not gonna use this drug. And if they're on systemic corticosteroids, no. You don't want to use this drug.
If they're inhaled, that's OK. If they're cute on the skin, that's OK as well. And you really want the cats preferably to be on wet food or be given extra cat soup, that sort of thing to keep up the water hydration.
And you have the rule that if they don't eat, then they're not allowed their drug because if they're not eating, then that's gonna lead to dehydration, early signs of. Something not going right, but remember that data that I showed you to start with 75% of cats were either a lot or. Markedly improved when they had meloxicam, when they had arthritis.
So you really want to think about getting their pain and inflammation under control. What other drugs have we got? Cause we do now have our other drugs.
Gabapentin, a friend, and particularly as you can get it from Bova which is it's a chicken flavoured paste. That tends to go down pretty well. So, gabapentin, what I would do is I'd say start low at that 5 makes per kg, first few doses, because it can make them wobbly.
You don't want to make a cat that's arthritis wobbly because they might fall. So, make sure they're OK and then increase that. Another drug that I didn't used to be able to use very much, which is Mantaine.
Didn't use it a lot because the human products were incredibly bitter, the liquid and the tablet. But I think Summit now do it, and apparently it's, not bitter, so that's a good option. What about ketamine subQ?
I, I had to get my head around this, but of course, both of these are gonna work on the, MDA receptors. And that's gonna stop wind up, and that's a good thing. So considering including one of these in a, a multimodal treatment regime for an elderly cat with arthritis would be a good way to go.
And it's a tiny dose, and it's given subcu. That is a bit stingy, but that can last from a week to a month. I know, it's crazy.
But that is a, a, a possibility. Tramadol I don't use and certainly know with 50% of cats, it doesn't work, and I, I don't wanna play with those odds. .
By way of the opiates, buprenorphine, buprenorphine by mouth. And the way I would do it is put a tiny little smear on, of something like licky licks, something the cat really likes, on a plate. And then you drip the buprenorphine.
On that. And then because the cat's got a really lick to get this smear of whatever it really likes on the plate, the action of licking will get it all the way around their mouth. And that means you don't have to be pushing things into the mouth of an elderly cat who doesn't like it.
Then little patches, I can't keep them on. I wear my own for my back, but not, not for cats. And methadone, I haven't used much for cats, unless they're coming into the clinic.
What about Calencia? We've got, through, for. I really can't say that very well.
And I'm loving Calencia. I'm finding it a really, really good analgesic. It's licenced for arthritis, so you're using it absolutely on licence here.
What I would say is it's just a painkiller. It's just that they're marketing it for Arthritis, it also works well for dental pain, even works for pancreatic pain, so visceral. Somatic Remember, it's a good painkiller that you can give once a month.
What we do find is about 1 in 100 cats something up there, it's considered a common side effect, they can get really itchy around their face. If they do, then you have to stop. What about, Galiprat?
Well, the studies, there is a study that showed it worked very effectively. So that is, would be off-label. And you'd need to have considered, other things first.
It doesn't mean you have to use them first, but you obviously would have done. So Galipprank is another possibility. What about other interventions?
These really, we, we don't have data for, but obviously increasing movement makes sense. Personally, water box, I don't think, that cat's not happy. That's not where I'm gonna go.
Remember, massage. Physiotherapy absolutely can help these cats. You know, the, the laser therapy, some people feel that that works very well.
You know, the, the, the local laser, the local ultrasound as well. Acupuncture, I have gone to quite a lot, particularly for spinal pain. The cat with Sam Linlett's name on.
He's hitting 0s there. Now, he was very aggressive because he was in so much back pain. Nothing I could do helped.
So what, I did, I asked Sam to have a look at him. She put the needles in. Now, the first time we did sedate him because we wouldn't have got anywhere close.
But it really helped him. The second time, he lay there, no sedation. But he grumbled a lot.
I was ready to sedate him, but we didn't need to. This is the 3rd time. He just came out and splatter on the table.
Happy, but stick needles in me. You probably can't see the little cat at the bottom, but if you pull up the screen, you'll see she's got all her needles in. That's little Zelda.
It's really helped her as well. What about stem cells? Well, this is something that's being looked into.
Of course, effort stem cells are very sexy. But all they are is an anti-inflammatory agent. That is, that is, that there's people who want to think it's voodoo and magic in there, but they, they just, they, they push the cytokines so that you've got a, it's an anti-inflammatory.
It doesn't have to be put into the specific joint. You can just give it IV. It will get to all the places that are inflamed, which is why it might also help the asthma.
If it's asthmatic, it might help his kidneys. If he's got chronic kidney disease. It might help its gingivo dermatitis, if he's got gingivo dermatitis, which is actually where we're looking to use it.
So stem cells. But in Britain, we're Only licenced in cats to use, autologous grafting. So you would need to take about 2 grammes of fat from the cat.
So you are gonna have to have a little anaesthetic. But if you're doing a dental or something like that, that would be a good time to get some fat from under the skin. That's the best fat.
And then buy a best will raise the cells up for you. If the cat has FIV, they don't raise up properly. It's just one of the things we've discovered.
And then radiation, if you've got a practise close to you that's got a linear accelerator. Then if you've got a particular individual joint that is really inflamed, you can use a low dose of radiation. That was quite a long slide.
What about surgery? Well, surgery, the, the, the top procedures, so tyres transpositions like beautiful mort like needed, femoral head resections, which we're seeing, needing for hip dysplasia, but also for, slipped capitus, slipped femoral capituitu. So when the growth.
Plate slips. We used to call it, femoral neck necrosis, but it's not truly a necrosis. It's a, the, the growth plate slips.
Particularly big Maine Coon boys, and big British shorthair boys, girls occasionally too, in both breeds, but usually it's the big heavy ones, usually by the time before they're too. So that is why the advice for neutering these cats has now changed, which is why McDuff is still, entire, because you want to keep them to at least 14 months old for their growth plates to close. Because obviously, if you neuter them, they're gonna stay open for longer, so the risk we think might be higher.
So if you've got people with Maine Coons, if they can stand the smell of the pee, then, That's the way to do it, to be honest. My boy Bear is. So other than the fact is PE is weaponizable, there's no problem.
Arthrodesis, obviously, would be, for severely, for example, that would be typically collapsing hocks. They are salvage procedures. If what you get is acute episodes of pain in one joint that it might be a cartilage mouse, then, then that can really be a helpful thing to do.
So, that is us through, arthritis. But I do want to thank you, make you think back to Sally. So, think about our little Sally, think about all the interventions that we could have done.
Think about what you would do. So you're a 16 year old cat that is defecating sorry urinating outside the the litter box. What things are you gonna do?
So the obvious things. All the things about the environment, you're gonna do those first. So that is raising up food and water bowls.
It really makes such a difference. You know, much more effective than most drugs, I think, as a starting point. It really is a game changer.
Making sure that they've got a low bit to the litter box that they can get into, that they can get to all the places they want to get to, that might be, meaning, providing steps for them, possibly a light so they can see where they're going. Warm beds, massage, all of those things, easy things to do. Owners can learn massage if they, if they.
If they pet the cat, then they can massage the cat. And then moving on from that, it would be counterprotectants. So all of the, my preference with green lip muscle do need more data, but that's the one that's looking good, but the combination ones are a very good way to go.
And if that's when that's not enough, add in meloxicam, but make sure to check the kidneys first and then follow up checking the UPC to sit, make sure that the meloxicam hasn't increased the the, the protein loss in the urine. And then if that's not enough, you start thinking about gabapentin, you start thinking about, Calencia, you go to Salencia first because it's once, once a month. And it's a bit of a pain doing, gabapentin because it's a controlled drug.
And then, if that's not enough, think about Amantadine, think about ketamine. And I both of those are gonna stop lined up. So I hope that was useful for you.
And I look forward to, any questions that you, post, and I will see you again, when we do the second half of this in July. So thank you very much. Take care.