Have you implemented AAFP/AAHA Feline Life Stage Wellness Guidelines? (Proceedings)

Cats currently are the most popular pet in America, and are considered a family member by many cat owners. Despite these facts, cats do not receive the veterinary care they need; in 2006, only 64% of cats (compared with 83% of dogs) visited a veterinarian (1). Reasons include the misconception that cats "can take care of themselves"; signs of illness are difficult to detect since cats are masters at hiding illness and pain; and the stress and fear associated with the carrier, car, and veterinary visit. Cat owners site other reasons: they did not know the care necessary, the veterinarian did not recommend it, and that the need or benefit was not well explained. (2) In light of this troubling information, the CATalyst Council, a national initiative to champion the cat, identified the need for Feline Wellness Guidelines to improve client communication and education of the benefits of regular veterinary care, and how to facilitate getting the cat to the veterinarian are essential to improve feline health care. The goals of the AAFP-AAHA Feline Life Stage Guidelines (available here: http://www.aahanet.org/PublicDocuments/FelineLifeStageGuidelines.pdf) are to provide 1) Optimal healthcare recommendations for cats throughout their different life stages, and 2) Practical suggestions and tools to facilitate improved veterinary visits and to enhance the client-veterinarian clinical encounter.

The life stages were chosen to focus attention on the physical and behavioral changes that occur during the lifespan (e.g., congenital defects in kittens; obesity prevention in for junior cats). These stages are: kittens (up through 6 mo of age); junior (7 mo through 2 yr); adult (3 through 6 yr); mature (7 through10 years); senior (11 through 14 years); or geriatric (15+ years) (3,4). It is important to remember that individual animals and body systems age at different rates, and that any individual can have a condition not common to that life stage.

The wellness visit

History

Effective history-taking includes the use of open-ended questioning (e.g., "How has [cat's name] been doing since the last visit?") (5), combined with a template or checklist to ensure specific topics are covered during the history.

General education

Client education for cats of any age should include recognizing early and subtle signs of pain or illness, importance of prevention and early detection of disease, health-care financial planning, disaster preparedness, estate planning, and microchipping.

Physical examination

A minimum of annual examinations and consultations are recommended for apparently healthy adult cats, and semi-annually for cats 7 and older. Semi-annual wellness exams for cats of all ages often are recommended by veterinarians and veterinary organizations because changes in health status may occur in a short period of time; ill cats often show no signs of disease; earlier detection of illness, including "silent" disease, such as obesity and dental disease, allows for earlier intervention. In addition, semi-annual exams allow for more frequent communication with the owner regarding behavioral and attitudinal changes, and education about preventive healthcare.

Panel members concluded that preventive veterinary care can improve quality of life, detect illness earlier and, reduce the long term expenses associated with a cat's health care, and that further research is needed to identify the optimal examination schedule to maximize the health and longevity of the cat.

Minimum data base

A minimum database (MDB) allows for early detection of disease, a baseline for interpretation of data from subsequent visits, and trends in laboratory parameters that may be of concern. Specific recommendations about age and frequency of laboratory testing depend on many factors. One consideration is that the incidence of many diseases increases with age.

Nutrition and weight management

Diet basics

Energy and nutrient needs vary with life stage, sterilization status, and activity, so general feeding recommendations provide only a starting point. Individual intakes must then be adjusted to maintain the desired body and muscle condition score.

Both canned and dry foods have been found to support health during all life stages (6). The presence of a label guarantee that the food was tested using feeding trials provides the current best initial evidence that a diet is satisfactory.

Despite the concern surrounding the effects of carbohydrate in dry foods, current evidence suggests that the effects of housing and activity (which may be a marker of welfare [7]) are more significant predictors of health (8, 9, 10). Current evidence does not support carbohydrate content of foods as harmful or as an independent risk factor for diseases such as obesity or diabetes (8,11).

With regard to home-made foods, the veterinarian should discuss and share evidence about nutritional balance, risks associated with preparation and feeding of foods raw, and advantages to using food formulated for cats, referring clients to additional resources if indicated.

Feeding regimens

A variety of feeding styles can maintain good health in client-owned cats, including free choice or providing meals. In addition to monitoring intake, promote water intake via bowls, dripping faucets, and/or fountains. When increased water intake is desirable, feeding canned foods may help achieve this. Locate water and food in a quiet area, especially for nervous or fearful cats (e.g., away from other animals or household items that may make noises intermittently). Offer dry foods in food balls or puzzles, or in multiple small meals in several widely-dispersed bowls to slow intake and increase mental and physical activity.

Obesity may occur at any age, most commonly in middle age. The risk of obesity may be reduced by environmental enrichment, increasing opportunities for activity, and individualizing food intake. The energy density of cat foods varies widely, based on the moisture and fat content of the diet. Sterilized cats generally need fewer calories than do non-sterilized cats, but intakes still must be individualized to maintain the desired condition.

Behavior

Cats of all ages have the following needs:

• Resources throughout the home—hiding spots, elevated resting spots, food, water, scratching posts and litter boxes. The more cats in the household, the more resources needed.

• Most cats prefer unscented clumping litter (Borchelt 1991), larger boxes, approximately 1.5 times the size of the cat from the tip of the nose to the base of the tail, and clean litter boxes in accessible - but not busy - locations. Litter box rejection can result from variety of causes including box size, litter type, box cleaning, box style and external environmental threats unrelated to the litter box.

• Environmental enrichment is very important for all cats, especially indoor cats, because boredom causes stress in cats and frequently leads to obesity. The environment can be enlarged safely with outdoor enclosures or supervised outdoor activity (e.g., walking the cat on harness and leash, or in a stroller).

• Opportunities for play also are important, and may reflect cat's hunting preferences.

Additional information on resources for indoor cats is available at www.indoorcat.org.

Kittens

Kittens have a strong drive to play. Inter-cat social play peaks at about 12 weeks of age, after which object play becomes more prevalent. Toys offer an outlet for normal predatory sequences as part of play, and help prevent play biting. The primary socialization period of cats to people is from 3-9 weeks of age. If kittens associate positive experiences with exposure to people during this age, they will be more willing to approach people and be held by people later on in life. Kittens should be handled gently and positively. Expose kittens as early as possible to any stimuli or handling techniques the cat may encounter during their lifetime (e.g., children, dogs, nail trims, tooth brushing, car rides). Always reward positive behaviors using food or other appropriate rewards; never punish the kitten as it may elicit defensive aggression.

Junior

Inter-cat relations may change when a cat reaches 1-2 years of age (the age at which free-living offspring leave the family unit) and may lead to inter-cat aggression. Most intact cats and about 10% of sterilized cats mark territory with urine, and onset can coincide with sexual maturity.

Adult and mature

Declining play activity in adult and mature cats increases susceptibility to weight gain. Three 10-15 min play sessions per day can lead to a loss of approximately 1% of body weight in one month with no food intake restrictions (12).

Senior and geriatric

Behavior changes in senior cats are common (e.g., vocalization, changes in litter box usage) and usually indicate an underlying medical problem (4).

Parasite control

Both animal and environmental control are important during all life stages. All cats, including indoor cats, are at risk for roundworms, hookworms, and heartworms, and should receive preventive against these. Fecal testing is needed despite use of preventives.

Because prenatal infection does not occur in kittens, biweekly roundworm treatment can begin at 3 weeks of age; kittens may begin receiving a monthly general endoparasite preventive at 8 - 9 weeks of age. (CAPC 2008)

Additional details may be found at:

• Council on Parasite Prevention (CAPC): www.capcvet.org/recommendations/guidelines.html

• American Heartworm Society: www.heartwormsociety.org/article_1142.html

• KNOW Heartworm: www.knowheartworms.org/

• The United States Centers for Disease Control (CDC) web site also provides information on a variety of zoonoses: http://www.cdc.gov/ncidod/dpd/animals.htm)

Retrovirus testing

The retroviral status of all cats should be known to inform both wellness and illness care. All cats should be tested for FeLV and FIV when they are adopted, regardless of age. Retrovirus testing can be performed even on kittens a few days old. Cats testing negative should be retested a minimum of 30 days later for FeLV, and after a minimum of 60 days later for FIV. Antibody tests for FIV can detect antibodies passed in colostrum from an infected or vaccinated mother, which can be mistaken for infection in the kitten. Kittens that test positive for FIV antibodies should be retested every 60 days up to 6 months of age because FIV tests can detect antibodies passed from an infected or vaccinated queen causing a false positive; if kittens becomes seronegative, they are most likely not infected. It is important to remember that retroviral tests can diagnose only infection, not clinical disease, and cats infected with FeLV or FIV may live for many years.

Cats should be retested following exposure to an infected cat or a cat of unknown infection status, prior to vaccination against FeLV or FIV, and prior to entering group housing with unknown retrovirus status. Cats living in households with other cats infected with FeLV or FIV should be tested on an annual basis unless they are isolated. Sick cats should be tested even if they have tested negative in the past.

Vaccination

Core feline virus vaccines; panleukopenia, herpes -1, calici, and rabies should be given to all cats. Panleukopenia, herpes -1, and calici vaccines should be administered to kittens, revaccinating every 3 to 4 weeks until kittens are a minimum of 16 weeks of age. Revaccinate one year later, and then every 3 years. Rabies vaccination should be given in accordance with local or state statutes.

The FeLV vaccine is highly recommended for all kittens due to unknown future lifestyle. It is also recommended for cats that go outdoors, cats that have direct contact with cats of unknown status or in high turnover situations such as foster homes or other group housing, and cats that live with FeLV-positive cats. These cats should be vaccinated annually.

Dental care

Although dental disease is extremely common, most owners aren't aware that it causes pain, and can threaten the cat's health and welfare. Education about oral health care is crucial at all life stages to increase awareness that cats need both home and veterinary dental care.

• Discuss owner-usable interventions that will maintain or improve dental health (13). Tooth brushing is best started with kittens, but older cats can be taught to accept brushing using positive interactions and rewards.

• Other home dental products exist, including dental diets, treats, and chews. Efficacy of products is not equivalent, and the only known effective dental products are those approved by the Veterinary Oral Health Council, which requires extensive protocols before certification of food or treats for oral care.

Client communication and resources

Excellent resources are available to facilitate design of a comprehensive, life stage-targeted wellness care plan for each cat. Clear communication among veterinarians, support staff, and pet owners should improve adherence to the wellness plan, thus improving the quality of health care delivered to cats. This guideline may be used as a concise template for this purpose.

References:

Flanigan J, Shepherd A, Majchrzak S, Kirkpatrick D, San Filippo M (2007) U.S. Pet Ownership & Demographics Sourcebook, American Veterinary Medical Association, Schaumburg, IL: 1-3.

AAHA Compliance Study, AAHA 2003; AAHA 2009, www.aahanet.org.

Adams V, Bowen J, Caney S, Cannon M, Cory J, Dye C, Falconer-Taylor R, Forcada Y, Foster D, Galloway P, Gruffdd-Jones T, Gunn-Moore D, Halls V, Harvey A, Heath S, Hibbert A, Horsford K, Jackson M, Kiddie J, Kraijer M, Mackay M, Mils D, Neville P, Reed N, Riccomini F, Rudd S, Schwartz A, Simpson K, Sparkes A, Tabor R, Tasker S, Taylor S, van de Stadt-Gould M, Wills S (2008) WellCat for Life Veterinary Handbook, Feline Advisory Bureau, Tisbury, Wiltshire UK p. 5 www.fabcats.org accessed 6/1/2009

Pittari, J, Rodan I, Beekman G, Gunn-Moore, D, Polzin D, Taboada J, Tuzio H, Zoran D. (2009) American Association of Feline Practitioners' Senior Care Guidelines. Journal of Feline Medicine and Surgery 11: 763-778 available at www.catvets.org accessed 6/1/2009.

Silverman J, Kurtz S, Draper J. (2005) Skills For Communicating With Patients, 2nd ed. Radcliffe publishing, SF: 43

Plantinga EA, Everts H, Kastelein AM, Beynen AC. (2005) Retrospective study of the survival of cats with acquired chronic renal insufficiency offered different commercial diets. Veterinary Record 157:185-7.

Yeates JW, Main DCJ. (2008) Assessment of positive welfare: A review. Veterinary Journal 175:293-300.

Slingerland LI, Fazilova VV, Plantinga EA, Kooistra HS, Beynen (2009) AC. Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus. Veterinary Journal 179:247-253.

Buffington CAT. . (2002) External and Internal Influences on Disease Risk in Cats Journal of the American Veterinary Medical Association 220:994-1002.

Robertson ID. (1999) The influence of diet and other factors on owner-perceived obesity in privately owned cats from metropolitan Perth, Western Australia. Preventive Veterinary Medicine 40:75-85.

Backus RC, Cave NJ, Keisler DH. (2007) Gonadectomy and high dietary fat but not high dietary carbohydrate induce gains in body weight and fat of domestic cats. British Journal of Nutrition 2007;98:641-50

Clarke, D. L.; Wrigglesworth, D.; Holmes, K.; Hackett, R.; Michel, K. .(2005) Using environmental enrichment and feeding enrichment to facilitate feline weight loss J Anim Physiol Anim Nutr 89 (11-12):427.

Ray JD, Jr., Eubanks DL. (2009) Dental homecare: teaching your clients to care for their pet's teeth. J Vet Dent 26:57-60.