Monday, February 1, 2016

How can you tell if a cat is in pain? and other important feline questions answered by Dr Susan Little

Dr Susan Little with Zanzibar.

When it comes to all things feline, Dr Susan Little is one of the big players on the international field. She is the owner of Bytown and Merivale Cat Hospitals inOttawa, Canada. She serves on the board of the American Association of Feline Practitioners and the National Board of VeterinaryMedical Examiners.

She is also am the editor and co-author for two textbooks: The Cat – Clinical Medicine and Management (2012) and August’sConsultations in Feline Internal Medicine volume 7 (2016)  . She is visiting Australia later this year to talk at the Centre forVeterinary Education’s Feline Medicine conference. Two topics she will be discussing in detail include feline pain and feeding the anorexic feline patient. Despite her hectic travel schedule, she took some time out to share her thoughts with SAT.

What motivated you to become a feline specialist?

I’ve always been primarily interested in cats, and entered feline-only practice not long after graduation. It was a logical step to pursue board certification in feline medicine to help develop my skills and my career.

Why is feline pain challenging to recognise?

Cats are skilled at hiding their signs of illness and pain as part of their survival mechanism. Their signs of pain are therefore different and often subtler than those seen in dogs and people. In addition, pet owners have a different relationship with their cat than with their dog; it’s often less interactive especially in terms of exercise and feeding, so that lethargy and decreased appetite are not noticed as quickly in a sick cat as they are in a sick dog.

Cats and kittens can be very hard to read.
How do you identify/quantify feline pain in your practice?

Unfortunately, there are few validated pain scoring systems available for cats. For musculoskeletal pain, I recommend the Feline Musculoskeletal Pain Index from Dr. Duncan Lascelles at North Caroline State. For acute pain scoring, I recommend the Glasgow Composite Measure Pain Scale for cats.

How can we do better in terms of recognising pain?

I think it’s important for veterinary practices to adopt a pain scoring system and to train all staff that are involved in patient care to recognize pain in cats and use the scoring systems.

Do you believe vets treat feline pain adequately?

Studies in different countries have consistently shown that cats receive less analgesic treatment than dogs and veterinarians view analgesia for cats differently. We have a long way to go to improve the delivery of analgesia for cats!

Currently in Australia we have an increased range of analgesia options for cats, the most commonly used being non-steroidal anti-inflammatory drugs and opioids. What range of analgesics do you use?

While we have a limited range of licensed products available for cats in most countries, pain management should always be multi-modal. Drugs from different classes can be combined (such as NSAIDs and opioids) and other options, such as local or regional analgesia can be used in many cases. There is no ‘one size fits all’ when it comes to pain management – it should be individualized to the patient and the procedure or disease.

How has your management of feline pain evolved?

The introduction of pain scoring systems as well as improved knowledge about analgesic drug (and non-drug) options for cats has changed the face of feline medicine for the better.

Why is anorexia such a common problem in feline patients?

Many cats are fed free choice so that owners actually do not know how much their pet eats each day. Therefore, it can take some time before decreased appetite is noticed by the owner. In most veterinary hospitals, the actual food/caloric intake of hospitalized patients is not measured.

What underlying conditions are most frequently associated with anorexia?

Stress and pain are common causes of decreased appetite in cats that is often overlooked. Disease in almost any body system can affect appetite, including dental or oral disease, gastrointestinal disease, urinary system, etc.

Is there a place for using appetite stimulants in cats and when do you usually use these?

Appetite stimulants tend to work best for cats that are hyporexic (versus anorexic) and that have not been off their food for very long. Food intake should always be measured in patients treated with appetite stimulants so that the next level of intervention can be employed (such as a feeding tube) if they are not successful.

Is there a problem with the types of foods being offered to cats in veterinary hospitals?

Cats that are sick or stressed will benefit from being fed familiar foods so it is often useful to ask the owner to bring food from home.

What can vets and vet nurses do to stimulate cats to eat or increase the chances that they will eat?

A calm and quiet environment can be very helpful as well as hand-feeding or coaxing. Pain prevents many cats from eating, so it should be addressed. It’s also important to recognize and treat nausea before trying to feed a cat to avoid food aversion. Providing an optimal cage environment including a place to hide may encourage shy cats to eat.

Thank you, Dr Little, for sharing your feline wisdom. If you want to catch Dr Little while she is Down Under, she will be speaking at the Valentine Charlton Feline Conference in Melbourne from June 20 to 23. Register here.