/// QUARTERLY BEAT / DECEMBER 2022
QUARTERLY BEAT / DECEMBER 2022 ///
In Lucy’s case, the physical examination, radiographs and urinalysis are normal by the time she is evaluated, leading to a diagnosis, by exclusion, of FIC. While hematuria is generally present in cats with FIC during the time clinical signs are occurring, this manifestation can be intermittent and may be resolved by the time of the examination. Knowing that FIC is a stress-related disease, the next challenge is for the owner and veterinarian to determine the
and use of climbing trees, scratching posts and perches next to windows with views to capture her interest. For Gus, finding ways allow him to “escape” from the new puppy whenever possible is also indicated. LITTER BOX MANAGEMENT is another important factor. Cats will preferentially eliminate in litter boxes free of obstacles, so frequent cleaning is important
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Feline Stress and Urinary Disease: A Multimodal Approach to Stress Mitigation Addresses Both Cause(s) and Effect(s)
potential source of Lucy’s stress. In her case, the presumed cause is boredom. Lucy was accustomed to her owner’s constant presence, and it is likely she is finding her new-found solitude and its accompanying lack of environmental stimulus to be stressful. In Gus’s case, the bladder was very small on physical examination and he urinated a small volume of red tinged
to promote elimination in the litter box. 2 Keeping the litter box in a quiet, low- traffic area will also help keep cats from experiencing anxiety while urinating. Behaviorists advise having a litter box on each floor of the house and maintaining one more litter box than the number of cats in the house. A household with one cat should have at least two litter boxes, a household with two cats should have three litter boxes, and so on.
MICHAEL LAPPIN , DVM, PhD, DACVIM (SAIM) Kenneth W. Smith Professor in Small Animal Clinical Veterinary Medicine Director, Center for Companion Animal Studies College of Veterinary Medicine and Biomedical Sciences, Colorado State University
In this VETgirl feature article sponsored* by Purina, Dr. Michael Lappin reviews “Feline Stress and Urinary Disease.”
urine when palpated. The urinalysis performed on this urine reveals hematuria without pyuria, struvite crystalluria, and a pH of 8 ; radiodense uroliths are not noted on radiographs. Gus is diagnosed with stress associated FIC without current urinary obstruction. Since this patient is male, he has a long, narrow urethra that is vulnerable to blockage. Because he is also overweight and consumes relatively high levels of magnesium and phosphate in his diet, Gus might be predisposed to urinary obstructive disease even before experiencing the recent stress of living with a rambunctious new puppy. However, this ramp- up in stress level likely triggered his normally acidic urine pH to become more alkaline, causing crystallization of the magnesium phosphate molecules which may be associated with urethral inflammation and partial obstruction. Complete urethral obstruction can occur, which is life-threatening. If chronic, non- obstructive disease occurs, struvite urolithiasis may develop. Thus, it is appropriate for veterinarians to check for urinary stones when a cat is brought to the clinic with periuria that might relate to stress in the home environment. STRESS THERAPY: MAKE IT MULTIMODAL A successful stress management program addresses both the source(s) of stress and its physical effects. While medications can certainly play a role in treating stress-related diseases, some of the most effective therapies do not involve drugs. Paying attention to the environment is especially important with urinary disease, and multimodal environmental modification (MEMO) is a vital strategy for reducing feline stress. 1 The key is to implement enrichment and stress-reduction strategies that will make Lucy feel more comfortable in her environment. Lucy’s owner also needs to understand that when she goes to work each day, Lucy needs her own “jobs” to fill the absence. These jobs can revolve around toys that make her work to get food; toys that allow expression of her play and predatory behaviors;
There also is evidence that diffusers that emit synthetic versions of F3 feline facial pheromones may be effective in relieving stress and promoting a sense of well-being. 3 In multi-cat households, pheromones that promote a calming effect can also help reduce inter-cat aggression. Dietary intervention 4 and probiotic supplementation are other cornerstones of managing cats with stress- related conditions. A diverse and healthy gut microbiome is paramount to health, but stress can adversely affect it. Something as simple as a change in housing can adversely alter gut microbiome composition and contribute to stress- related illness in cats. My research group performed the following studies on the effects of probiotics on feline health and the mitigation of stress-related conditions. • Enterococcus faecium SF68, the probiotic in FortiFlora and FortiFlora SA supplements, has immunostimulatory effects and has been shown to reduce those changes in the gut microbiome that occur due to stress. 5 In a placebo-controlled pilot study of 12 cats with chronic feline herpesvirus (reactivation of FHV-1 is a known marker for stress in cats), cats in the probiotic- supplemented group had more stable fecal microbial diversity than did control animals. Although results varied among individual cats, overall results suggest that SF68 lessened morbidity associated with chronic FHV-1 infection in some cats. 5 • Another study demonstrated the efficacy of Bifidobacterium longum BL999, the probiotic in the Calming Care supplement, in reducing signs of stress in cats by presumably affecting the gut-brain Continued on page 6
While the causes of stress in companion animals can vary significantly from species to species, as well as from individual to individual, there is no question that stress can have negative physical effects. Many owners who have boarded their anxious dogs are familiar with the tendency for them to develop acute diarrhea. While cats can also suffer gastrointestinal effects from stress, respiratory complications from the reactivation of feline herpesvirus type-1 (FHV-1) or feline caliciviruses also occur. Feline lower urinary tract disease (FLUTD) is the umbrella term for diseases affecting the lower urinary tract and the most common cause, feline idiopathic cystitis (FIC, also known as feline interstitial cystitis), is believed by most veterinarians to be a stress associated syndrome. FIC may also be associated with development if urolithiasis. One of the unfortunate manifestations of FLUTD is the tendency for affected cats to urinate in places other than their litter boxes (periuria) which can lead to relinquishment by owners--the consequences of stress in cats can clearly be dire. Let’s consider a couple of hypothetical feline patients and how stress affects them: • “Lucy” is a 2-year-old spayed female whose owner adopted her as a kitten when she was working from home, but recently returned to an 8-to-5 office job. Once indulged and played with throughout the day, Lucy is now alone for 9 hours per day. She recently began urinating outside her litter box in the laundry room. • “Gus” is a neutered, overweight, male middle-aged cat living in a household that acquired a new puppy several months ago. Like Lucy, Gus recently began urinating outside his litter box and is also urinating more frequently than in the past and appears to be straining and
uncomfortable when he does so. While these patients have different circumstances and may have different conditions, both are likely to be suffering from stress. In addition, both likely have unhappy owners who are mystified by their cats’ sudden “bad” behaviors. Luckily, Gus’ and Lucy’s owners will have made appointments with you, their veterinarian, before taking any drastic action. THE WORKUP AND THE RESULTS Inappropriate elimination is often—and wrongly—perceived to be a purely a behavioral problem by cat owners. The reasons are typically complex, with emotional and physical factors intertwined. Lucy’s and Gus’ workups should include urinalysis and radiographs to screen for urinary infection and radiodense urinary stones —the former of which is relatively rare, but possible, in cats. Depending on the patient’s age and clinical signs, practitioners may also elect to conduct an ultrasound examination to rule out neoplasia. If screenings are negative for these conditions, a diagnosis of FIC can be presumed.
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