Preventive medicine for feline patients provides link to comprehensive care

May 1, 2003

Article

Veterinarians are busy individuals who multi-task with fervor. How else can we accomplish all that we must during the normal workday? We have to play the role of internist, pharmacist, radiologist, dentist, animal behaviorist, practice manager, human relations expert, environmental protection engineer, chief financial officer and employee/client counselor all rolled into one. Our job description is quite daunting and sometimes it helps to focus on our most important task at hand - keeping animals healthy. Here are the two most basic rules of veterinary practice.

Physical examinations are the foundation of well-health care for cats.

Rule 1: Prevent animal illnesses wherever possible.

Rule 2: Treat illnesses when rule number one doesn't work.

We will examine rule number one in relation to feline medicine. Preventing feline illness requires a regimented preventive medicine program that must be comprehensive and involve every member of the veterinary hospital team from the receptionist to the technician to the kennel worker. The veterinarian is the leader of the team and must educate the other members on the essentials of feline healthcare. But first, there must be a written preventive medicine program.

Developing a pro-active approach

So, how do we develop a feline preventive medicine program? We should start with the very basic requirements for life - food and water. Good nutrition is the foundation of overall health - no cat can survive without food. Cats are natural carnivores and usually require meat-based diets. Luckily, cat owners can choose from a plethora of Association of American Feed Control Officials (AAFCO) certified diets that are either commercially available from veterinarians or over the counter. Pet food manufacturers spend huge sums of money touting the benefits of their products and the feeding trials conducted by AAFCO verify that their pet foods meet quality standards. As veterinarians, we, along with our staff, must sift through the multitudes of dietary choices and decide which ones to suggest our clients feed their cats.

Routine testing for parasites and retroviruses is an essential part of keeping a cat healthy, with additional testing such as CBC, chemistry profile, thyroid testing, and urinalysis performed as warranted.

Nutritional needs vary with the cat's age and health status. Kittens should consume growth diets until they reach approximately 9 months of age and can graduate to adult food. In-clinic client education on nutrition can explain how clients should feed adult food in gradually increasing increments over several days to ease the transition from kitten food to an adult diet. Cats entering their golden years should transition to senior cat food in a similar manner. Specialty diets that address dental disease and hairballs are good preventive medicine diets that help avoid these health problems in susceptible cats. All cats should have their weights recorded with each office visit and special attention paid to any significant increase or decrease in weight.

Disease prevention

Preventive medicine programs always include vaccinations. Immunization protocols need to be carefully evaluated taking into consideration risk of exposure, disease implications, difficulty of treatment and potential vaccine reactions. Feline immunization is a complex topic and differing views abound pertaining to which vaccines should be administered and the frequency of administration. From a practitioner's standpoint, we should review the basic feline infectious diseases that are addressed by currently available vaccines.

Rabies is the grandfather of viruses and should be incorporated into every immunization program. Rabies is a rhabdovirus transmitted by bite wounds and vaccination protocols are often dictated by state or municipal regulations. Vaccinating cats establishes an important buffer zone that decreases the potential for zoonotic transmission to humans. Remember that rabies is a reportable disease. Vaccination is advised either annually or every three years depending on local laws and the type of vaccine used.

Table 1: Feline Preventive Medicine Program Age Related Exam Room Protocols

Feline panleukopenia is caused by a parvovirus which is spread by fecal-oral routes. This virus survives for months to years on fomites which favors its transmissibility. Since maternal antibodies interfere with immunizations, a series of vaccinations is given to kittens followed by revaccination a year later, and then every three years thereafter according to AAFP guidelines. Some veterinarians are more comfortable following the vaccine manufacturers' recommendations advising continuous annual re-vaccination.

Feline viral rhinotracheitis and Calicivirus are common viruses that cause approximately 90 percent of feline upper respiratory disease. These viruses are spread directly from cat to cat through respiratory secretions. Sneezing cats are great transmitters of these upper respiratory viruses that cause medical problems in catteries, animal control facilities and boarding kennels. AAFP vaccinination recommendations follow the same guidelines as for feline panleukopenia.

Good feline preventive medicine programs begin with the basics, such as proper nutrition for the cat's age and health status.

Feline leukemia virus (FeLV) is a retrovirus transmitted via respiratory secretions often through the sharing of food and water bowls or litter boxes. Signs of feline leukemia virus are often related to the immunosuppression caused by the virus, although a plethora of symptoms are possible since the virus can lead a host of other problems such as blood disorders and tumors. Vaccination recommendations are based on the age of the cat and the risk of exposure. Cats younger than 4 months of age are more susceptible to infection. Young cats that wander outdoors or kittens living with FeLV positive cats may benefit from vaccination. Since many "strictly indoor" cats eventually find their way outdoors, many veterinarians include FeLV as a routine part of their annual vaccination protocols.

Feline immunodeficiency virus (FIV) vaccination is quite controversial due to the interference of vaccinating with diagnostic testing. Like FeLV, FIV is a retrovirus and causes immunosuppression. FIV is spread primarily though bite wounds making cats that are born of negative mothers, live indoors and never fight at low risk. Conversely, cats of questionable ancestry, that roam outdoors and participate in neighborhood feline brawls, are at high risk of infection. Careful consideration needs to be given to FIV vaccination protocols dictated in preventive medicine programs. Veterinarians need to examine the degree of cross protection achieved by a bivalent vaccine against a virus with at least five subtypes or clades. The available vaccine (Fort Dodge) contains subtypes A and D, while the most prevalent subtype in the United States is subtype B. Currently available antibody tests (IDEXX SNAP, Western Blot) do not distinguish between a truly infected cat and a vaccinated one. PCR testing and virus isolation are not readily available to most practitioners and are quite costly for the client. With this in mind, the AAFP still advocates testing/isolation as the best means of preventing FIV. Still, vaccination of FIV negative cats living with FIV positive cats in an unstable social structure or cats living outdoors who fight frequently may be potential candidates for vaccination. Veterinarians must carefully weigh the benefit of vaccinating such an at risk cat against the future testing complications. Amid the controversy, one preventive medicine point is clear - all cats should be tested for FIV.

Other less frequently used vaccines may be included in basic hospital preventive medicine protocols depending on the incidence of disease in a particular practice. For example, vaccines for Microsporum canis, Bordetella bronchiseptica, Giardia lamblia, Chlamydia psittaci and Feline infectious peritonitis are available, but not routinely recommended for all cats. Infrequent usage of these vaccines can be attributed to one or more of the following factors: lack of vaccine efficacy, low incidence of disease, minimal severity of symptoms and ease of treatment. Veterinarians need to decide how important these vaccines are to the health of cats in their practice and may prefer to emphasize the core vaccines in clinic programs rather than these less frequently administered vaccines.

We must also consider the risk of vaccine-induced feline sarcoma. While some consider injection site sarcoma a significant problem, others are not impressed by the incidence. Nevertheless, over-vaccination is not something we aspire to and sticking to the important diseases and their related vaccines in preventive medicine protocols makes the program easier to master. We can add vaccines or increase frequency of administration as necessary on an individual case basis.

Feline parasitology

When it comes to feline parasites, staff education is again an essential element to a successful preventive medicine plan because receptionists sell most of the parasite control products. There are a myriad of parasites that thrive both in and on cats and an equal number of products to eliminate or prevent them. Veterinarians should be well informed of the most prevalent parasites in their practice area and include stringent preventive measures for those particular pests. In order to develop a good parasite control program, it is also necessary to be familiar with the major commercial medications on the market and their spectrum of activity.

Certain internal parasites prefer particular environments and climates; therefore, routine deworming of kittens as part of a preventive medicine program varies with locale. Regardless of practice locale, we should be aware of the Centers for Disease Control and Prevention (CDC) guidelines when establishing parasite treatment protocols. The CDC suggests routine de-worming of both kittens and their mothers when the kittens are 3 weeks of age. Kittens should be treated with oral parasiticides again at two-week intervals until 9 weeks of age. These guidelines not only protect the kitten, but also focus on the potential for zoonotic infection.

After treating kittens and cats for intestinal parasites, we want to keep them parasite-free with good parasite prevention protocols. The available medications on the market determine the content of our preventive programs. There are currently easy-to-use medications for hookworm and roundworm prevention in cats. Monthly oral preparations (Feline HeartgardÂ®) prevent heartworms as well as intestinal parasites. In addition to internal parasite control and heartworm prevention, the topical preparation (Feline RevolutionÂ®) treats ear mites and controls fleas. Other topical parasite preparations (Advantage, FrontlineÂ®) only address flea control, so clients need to understand the significant difference between topical feline products.

The abundance of parasiticides on the market is a blessing and a curse - a blessing because clients have so many from which to choose, but a curse because they are often confused by the number of products and choose the wrong one. A strong parasite control portion of a feline medicine program can guide clients in determining the best parasite protection for their cats.

Comprehensive care

Preventive medicine programs should include routine diagnostics to allow early detection of health problems. As stated before, the AAFP recommends routine testing for FIV/FeLV. The in house test kit available (SNAPÂ® combo by IDEXX) makes testing for FIV and FeLV easy to do during annual examinations. Regardless of age, cats benefit from routine retrovirus testing and regular fecal exams, but additional tests should be considered routine as cats age. A senior care program is an important part of a good preventive medicine plan for cats. Senior care programs should be implemented in cats older than 7 years of age, regardless of health status, and should include a CBC, chemistry panel, urinalysis and thyroid function tests. If clinic preventive medicine programs are instituted correctly, the number of senior cats in the practice should increase as should the practice income.

Reproduction is a preventive medicine topic that should be broached at the initial examination of young cats. Clients need to be educated on the health benefits of spaying and neutering. It may also help to mention the pet owner's responsibility in containing the pet overpopulation problem. Both doctors and staff should be willing to discuss the pre-surgical protocol (pre-op laboratory work, vaccination requirements), the anesthetic protocol and monitoring capabilities, the surgical procedure itself, hospital stay, pain management protocol and post-operative care. Informed clients are more apt to agree to spaying and neutering and feel better about the fees they pay when they understand how much is involved in a "routine" ovariohysterectomy or castration.

One for good behavior

Feline behavior is a topic that bears discussion throughout a cat's lifetime as part of an overall health program. It's more difficult to maintain a successful preventive medicine plan for the cat that is banished outdoors because he clawed up the new sofa. Behavior counseling is yet another area where our staff members are very helpful. Basics of litter box training, spraying, scratching, and aggression in multi-cat households are daunting problems for cat owners and they appreciate the time that staff members take to discuss these situations. Keeping the cat part of the family unit is not only an obligation, it makes us feel good and it provides the hospital with a long-term, loyal client who will bolster the bottom line of the practice.