QUARTERLY BEAT / DECEMBER 2023 ///
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Box 3: Five Pillars of a Healthy Feline Environment
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Provide a safe place
Provide multiple and seperate resources for food, water, toileting, scratching, resting/sleeping
FIC: ADDRESSING THE RISK FACTORS THAT MATTER MOST Kelly A. St. Denis, MSc, DVM, DABVP (Feline Practice)
Provide opportunity for play and predatory behavior
*Please note the opinions of this article are the expressed opinion of the author and not directly endorsed by VETgirl.
Provide positive, consistent & predictable human-cat social interactions
The AAFP and ISFM Feline Environmental Needs Guidelines describe the 5 pillars of a healthy feline environment (Box 3). 12 These are not to be confused with environmental enrichment, but rather represent the bare essentials that cats require in order to experience good cognitive, physical, and emotional health. Cats need to feel a sense of safety in their environment, with places to hide or perch, and with minimal intruders that may pose a threat to the cat’s safety or to the stability of the cat’s resources. While there is often a focus on litterboxes as a resource when a cat is diagnosed with FLUTD, attention should also be given to other resources including food and feeding stations, water stations, sleeping spaces, hiding and perching locations, scratching posts and toys. Toys represent an outlet for a cat’s prey drive. Cats need to engage regularly in play and predatory activities to satisfy their need to hunt. Toys may include those that the cat can play with independently as well as those that are reserved for interactive play with the caregiver. Regular, interactive play with the caregiver is one element of providing positive, consistent, and predictable human-cat interactions. All members of the household should interact with the cat in a respectful manner, allowing the cat to choose when to initiate and terminate interactions and never subjecting the cat to punishment or rough handling. Finally, the home environment should be arranged to respect the cat’s sense of smell and other senses, minimizing overpowering odors, lighting, or sounds. These have the potential to obtund the cat’s ability to detect predators, predisposing the cat to protective emotions including fear-anxiety and frustration.
Feline lower urinary tract disease (FLUTD) describes conditions that affect the urinary bladder and urethra that present with a variety of clinical signs (Box 1). The most common cause of non-obstructive FLUTD is feline idiopathic cystitis (FIC), 1–5 a diagnosis that requires exclusion of all other causes of FLUTD. Cats with FIC experience waxing and waning, often recurrent episodes, with approximately 15% of patients presenting with urethral obstruction. FIC is a complex condition, occurring as a result of interactions between the nervous system, the adrenergic system, husbandry practices and the environment in which the cat lives. 6,7 Cats predisposed to FIC exhibit abnormal responses to day-to-day stressors, with an exaggerated sympathetic nervous system response including increased catecholamine release, as well as blunted endocrine and cortisol responses. 8,9 Unlike their healthy counterparts, these cats are poorly equipped to handle a stimulus or challenge, and have an increased likelihood of developing sickness behaviors. This can manifest as an FIC flareup, or in some cats may affect other body systems including the gastrointestinal, immune, dermatologic, or respiratory systems. 6,7,10,11
Provide an environment that respects the cat’s sense of smell & other senses
Whether in a single or multi-cat household, ensuring cats live in a healthy environment can be achieved through identification and correction of deficiencies in these five pillars. Multi-cat households present additional challenges. Cats are by nature an asocial species, living in a defined territory with specific, protected resources. 13 When it comes to sharing that territory with other cats, cats may experience increased fear-anxiety and frustration related to their asocial nature. 14 Cohabitating cats may develop affiliative (‘friend’) habits, but many caregivers mistake co-existence for friendliness, even missing cues associated with agonistic (‘foe’) relationships (Box 4). Veterinary teams will need to work with the caregiver to elaborate on inter- cat relationships. In cases where cats are exhibiting agonistic interactions, correction of deficiencies in the five pillars may improve management of individual cat territories within the home. Consultation with a certified behaviorist is recommended.
Obesity, diet, and water intake are risk factors which are manageable with appropriate nutritional guidance. Development of a weight loss plan for obese cats should include assessment of current caloric intake, evaluation of the cat’s specific diet, and calculation of the cat’s resting energy requirements. 15,16 Body weight, body condition score, and muscle condition score trends should be monitored. 16 Overweight FIC cats are likely to benefit from a dietary change. Royal Canin Multifunction Urinary SO + Satiety + Calm is a therapeutic diet designed to promote healthy weight loss while helping to manage FIC. If weight loss is not required, adult and mature FIC patients are likely to benefit from formulations such as Royal Canin Multifunction Urinary SO + Calm or Royal Canin Multifunction Urinary SO Aging 7+ + Calm. The addition of canned food formulations may assist in any needed weight loss through portion control and reduction of intake. 17 Canned food is additionally beneficial for FIC patients due to its ability to lower urine specific gravity, potentially minimizing FIC flareups. 18 In situations where canned food cannot be fed, or where additional water intake is recommended, addressing patient water preferences includes evaluating desired drinking water temperatures, the cat’s preference for still or circulating water, specific water vessel shape preferences, and preferred water vessel locations. As the most common form of FLUTD, FIC requires an increased focus when evaluating cats with lower urinary tract signs. The role of stress in FIC reinforces the need to guide caregivers on the ideal characteristics of a healthy feline environment. 19 Risk factors for FIC are best addressed as part of a preventive approach, however promoting the resolution of flexible risk factors in a therapeutic plan for FIC patients offers the best opportunity for successful disease management.
Box 1: Clinical Signs of FLUTD
Box 4: Affiliative and Agonistic Interactions
• Hematuria • Stranguria • Vocalization • Pollakiuria • Dysuria
• Obstruction • Periuria • PAIN • Abdominal Barbering
Affiliative ‘Friend’ Interactions Facial rubbing or body rubbing between cats Tail wrapping Nose touching Resting or sleeping in physical contact or close proximity
Agonistic ‘Foe’ Interactions
Box 2: Risk Factors Associated with FIC
•
• Live in separate areas of house • Hissing/growling • Confrontational stares • Time-share resources • Resource-blocking • Monopolizing resources
Fixed
Flexible
• Genetics & Epigenetics • Sex • Neuter Status • Early Life Events • Age • Indoor Status
• Environment • Husbandry • Stress in a Multi-cat Household • Obesity • Diet • Water Intake
• • •
In order to prevent chronic, recurrent, or persistent disease, a multimodal approach to care should include analgesia for acute flareups, as well as therapies directed at any additional presenting problems or comorbidities. Targeting risk factors that are amenable to change offers a successful approach to long-term care. Many risk factors associated with FIC have been identified (Box 2). Some of these cannot be altered, while others can be successfully managed.
• Allogrooming • Playing together
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