Because so much thought must go toward a patient’s visit before, during and after they’ve left your clinic, some things may get glanced over when they shouldn’t. This is especially crucial when it comes to senior patients, which need extra special care and attention during their visits. Kelly St. Denis, DVM, DABVP, of Charing Cross Cat Clinic in Brantford, Ontario knows this all too well and shared with attendees at a recent CVC how to better manage your senior cats.
Spend more time with senior cats, and focus on their comfort
It doesn't take much time in their company to realize that senior cats don't handle stress well. So veterinarians need to stretch a little further with their time and their care to make sure that senior patients are as comfortable as they can be for their check-up.
First, remember that taking your time with feline senior patients is key. The average 20-minute appointment isn't enough to get through all that could be wrong with a senior patient. Try to extend it to 30-minute appointments to make your check-up more thorough.
Next, try letting patients out of their carriers and studying what they do for a bit. This gives you clues about what's going on with a senior feline patient. For example, look to see if they seem sore in certain places, note their body condition and generally try to get a sense of how they’re feeling.
A few more ideas for cat comfort: Get rid of smells that could raise the feline pulse. Consider using a Feliway (Ceva) diffuser to help calm feline patients. Designate a canine-free examination room to reduce stress-inducing scents. And your senior patients will always welcome warm blankets to curl up on and under.
Collect a full history at each visit
Knowing the history of your senior patient is imperative. Make sure the client is as thorough as possible to ensure that you’re up-to-date before starting your check-up.
Collecting a history can even take place before the check-up. Get a brief history before your client brings their patient into the clinic, with a list of questions ready-to-read off to make sure that you catch everything, every time.
This is also a good time to let the cat out of the bag—err, carrier—to study physical and behavioral issues while obtaining a full history. Again, this will give you a hint about what's going on with your patient before the physical exam.
Bonus: Remind clients that if a cat is an “indoor” cat that lives with a dog, she's not strictly an indoor cat—she can still catch “outdoor” hazards such as fleas, ticks and intestinal parasites from the dog's jaunts through the neighborhood or adventures in the backyard.
Play dumb when you're talking about medication
When doling out medications your client will administer, you need to teach the client the medication dosage and frequency, as well as how to administer the medication. Then turn the tables and ask the client to teach you how he or she will administer the medication.
If you're introducing the medication to the client for the first time, make sure that your client fully understands what, when and how often to administer the medication. When you ask the client to repeat what you’ve explained back to you, you can check for any flaws in the planned routine and make it more concrete for your client.
You can also use this approach for follow-up check-ups. You might say, “I left directions in the other room. Walk me through your process, please." This gives you a window into whether the client is administering the correct dosages at the correct times.
Talk about appetite and weight loss
Hydration, hydration, hydration! When asking about appetite and diet, mention water intake as well. For instance, cats can easily get their required water intake from canned food, especially if their diet consists of 100% canned food. If the patient is drinking water while eating a canned food diet, this could be a sign worth noting.
When you're discussing weight loss with clients, start by explaining the loss in terms of percentage of previous body weight. To emphasize the loss further, compare the percentage loss to your own body weight for the client. Would it be normal for you, the veterinarian, to lose over 20 pounds without reason? Absolutely not—and the same goes for the senior patient.
In the case of diet, address the fact that some senior diets don't consider the specific dietary needs of senior and geriatric cats. In many cases, as cats age and digestion efficiency decreases, cats will need increased energy and protein content in their daily intake.
Next. check the body condition score (BCS). Free online charts, such as Purina's Body Condition System Sheet, are excellent tools to determine the weight and visible health of your senior patients. Muscle condition scoring (MCS) should also be conducted for every patient at every visit.
Bonus: There are tons of other scoring charts and diagrams you can find for free online at place like the World Small Animal Veterinary Association. These include helpful BCS and MCS charts.
Check for signs of pain
Prescribing antibiotics is almost second nature to veterinarians. But when it comes to pain in cats, prescribing analgesics doesn’t always occur to the veterinarian. This is very likely in part due to the fact that cats are geniuses at hiding evidence of pain. If your senior pet is likely to be in pain, why wouldn’t you give pain medication? Even in the absence of obvious clinical signs of pain, if the patient’s disease or condition are likely to be painful, then analgesics are indicated.
Start by using pain assessment charts to check for pain and get your team on the same page about the care these senior cats need.
Also consider these tips and tricks you and your team can apply from check-up to check-up:
> If your senior patients seem painful, give pain medication beforehand and wait until they're ready to proceed with the check-up.
> Consider pain alternatives, such as acupuncture, massage and laser therapy, among others. Keep in mind that pain medicine should still be administered as well.
> Teach clients to manage their senior pets' weight to help manage pain. When a senior cat is painful, excess weight doesn't help.
> Don’t assume cognitive changes if a cat is not acting like itself. Rule out and treat medical causes first. Currently there are no tested diagnostic criteria or tested therapeutics for cognitive dysfunction in cats. Once all other diseases are ruled out or under control with therapy, environmental enrichment and other aids may reduce signs of cognitive dysfunction.
Managing senior feline patients is hard for the veterinarian, the patient and the client. “Even I have the same woes of pilling and medicating my cats that my clients go through,” St. Denis says at the end of her CVC session, talking about her two pet cats, which are both painful. “That’s just the way it goes.”
But getting to see even the smallest of improvements in painful patients can mean the world to everyone involved.