Senior Care

Madison’s story is just my story of how veterinary medicine has changed and may give you some of the why behind some of our recommendations for your senior cat. If you want to skip Madison’s story, just jump to the bottom to read what we recommend to keep all senior cats healthy.

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Madison was my first cat that I owned all by myself as an adult.  I adopted her from the SPCA in Saskatoon on my very first day of Vet School.  She was my study buddy.  She would travel to and from Nanaimo and Saskatoon every school holiday.  She was there with me when I was up all night studying and when I started my first job, she helped me through break ups and the loss of my mom.  She was always there and then she wasn’t.  And like all pet parents I wonder did I do right by her?  Did I wait too long to put her down or put her down too early?  Did I miss things?  It was 5 years ago now, at the age of 23, that I had to say goodbye.  What I want to share with you is what I think I did right by my girl in her senior years and what I now know I missed and will do differently with my Brandon-Muller who is now 12.

Medicine has changed in both the human and veterinary world since I graduated from veterinary school back in 1992.  Then we didn’t have options for treating arthritis or for treating itchy skin or even fleas for that matter.  Back in the early 90’s we used mousses and flea baths or an organophosphate product that if used inappropriately could have been lethal.   We did not radiograph teeth to see if there were abscesses or fractures hidden under the gums.  I wonder now how many dogs and cats had their teeth cleaned but the pet still suffered in silence because of a hidden abscess.

Well this story is about senior care and how things have changed.  Cats being cats, they are our most difficult pets to own and to treat, as they are masters at hiding any difficulties they may be having and Madison was no exception.

So what did I do right by my girl?  Back in the late 90’s it was a new concept to take blood on a seemly healthy pet, and so despite Madison’s protest I did her annual blood work from the time she was 7 until I started her in palliative care when she was 19.  Why?  I was looking for trends.  Renal Insufficiency (kidney disease) can be diagnosed in the early stages in cats as young as 7 and some studies show that cats over 15 have as high as a 49% chance of having some kidney insufficiency.  What we know is if we catch it early we can slow down, or prevent the progression, of the kidney damage and therefore our cats can live healthier and longer.  In the 90’s a typical owner would only bring their cat to the hospital when they were sick, we would have a history of the cat being sick for a couple of days but the blood tests told us the cat had been sick for much longer, months or years.  Did the owner lie?  Nope, cats are masters of deception and hiding when they hurt or are sick until that point that things are so far gone they can no longer hide their medical issue.

Anyway back to Madison’s story… So sure enough at 13 her blood tests showed a gradual trend of increasing BUN and CREATININE, which we use to help us determine her kidney function.  So I added to Madison’s senior screening and cultured her urine despite it looking normal.  This too was an unusual test to run but is now routinely recommended in all diabetics and renal insufficiency cases as underlying UTI can cause further damage to the kidneys, and in diabetic cases a UTI prevents the insulin from working properly and with the dilute urine that both of these diseases cause sometimes a UTI can go undetected without a culture.

Next thing I did right by my girl was that I routinely checked her blood pressure, as we know high blood pressure is not just a silent killer in people but can be common in our senior cats.  Madison’s BP remained stable throughout her senior years.

Then came my treatment plan.  Madison needed a new nutritional plan so as to keep her kidneys as healthy as possible.  She didn’t have an option of a transplant so I needed to keep those kidneys happy and so I changed her diet.  What is the easier than having to give a cat medication? Treating their health concerns through their diet!  So by using nutrition as my first step in treating my girl I was able to: 1. Control her phosphorus thus preventing further damage to her kidneys and help prevent nausea, 2. Control her BUN by increasing her fiber so she could excrete the urea through her feces, 3. Avoid uremic acidosis by the addition of potassium citrate, 4. Control her protein levels to slow down the production of certain metabolites yet ensure she was eating a calorie dense food so as to maintain her muscle mass.

I monitored Madison’s blood work, blood pressure and urine on an annual basis until it was time for palliative care.  I was lucky and because I caught it early my girl did great and with nutritional management alone I was able to control her real disease.

So what did I do wrong?  I missed her hidden pain.  60% of cats over the age of 7 and 90% over 14 have arthritis.  It is so prevalent that in continuing education lectures the experts on pain management consider arthritis as ubiquitous in our senior cat population.

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How did I miss it?  Because Madison, like all cats, was a master of hiding her pain until it was so severe that she finally started to have an obvious clinical sign.  Like most owners I jumped into action when she showed me she was hurting and I did radiographs and found she had severe degenerative joint disease of her elbows and back.  This did not start overnight.  She had been hurting for more than a day or two.  What was her first sign telling me she hurt? Limping? Nope.  Change in jumping?  Not that I noticed.  Did she cry or avoid petting?   All possible signs but for Madison she was no longer posturing normally in the litter box.  Because of this sometime some urine would go over the edge and onto the floor beside the box. In 2006 we did not have a lot of safe pain medications for cats, and in fact we are still limited today, but at the Fraser Valley Animal Hospital we are always trying to stay current with the best medical practices, and luckily for Madison we had just bought our first therapeutic laser.  Now fairly common, back then we were the first in BC to own one and so she was treated with laser therapy which was safe and effective way to help decrease inflammation and pain due to arthritis. We also added Cartrophen, which helped until she turned 19 when the arthritis treatment that was also safe for her kidneys was not enough.  Quality of life is always more important than longevity for my pets and so despite it not being a great medication for kidneys and could have potentially cause the progression of her renal disease I started Madison on Metacam just always ensuring she was well hydrated.  She lived 3 more years and she was comfortable.  The interesting thing is that many studies have now shown that cats with kidney disease whose pain is controlled, despite using low dose of a potentially nephrotoxic drug, actually live longer than when we ignore their pain.  Turns out I may have been ahead of my time.

The other 2 things I missed for my girl was the addition of water-soluble vitamins and Omega 3 oils.  Luckily being on a renal diet those smart nutritionists made sure there was an increase concentration of both of these in their diets but especially in her geriatrics years I wish I added both of these to her regime.

So as for my Brandon-Muller what do I do for his senior care?  Well he is 12 so yup he gets his blood work and blood pressure checked every year with his annual exam where I monitor things such as his dental heath and his body and muscle score.  He still runs and jumps and doesn’t show me pain but because he is a cat and is 12 he likely has some arthritis so I have him on Therabites, which is a glucosamine treat that my fussy eater loves!   I want to make sure his hidden pain doesn’t go untreated and if he starts to have a decrease in jump height, shows any signs of withdrawing from the family I will check him for arthritis and start him on pain medication earlier.  I still let nutrition be his first medicine and he is on dental care because he won’t let me brush his teeth, and canned senior support with added water and omega 3 oil.  At this time I do not give him the Amino B supplement but will add it to his diet when the time comes.  I do not know how long I will have my Brandon but while I do I want him to have a good quality of life and want him to have the longest life I can give him.

We believe that each and every cat needs to be treated as an individual.  There is not a standard plan that works for every cat as they all have their own family lifestyles, medical disease etc.  But here is the basic outline of what we recommend to keep our senior cats healthy.

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  • Starting at age 7 we do recommend continuing with your cat’s annual health exam and at this time start with some basic blood screening tests.  We do see renal disease in younger cats but our main goal is to get some base line values so that we can monitor for increasing trends rather than just normal or abnormal.  This allows us to catch things much earlier.
  • Starting at 10 we recommend now starting to run comprehensive blood and urine screening tests and checking your cat’s blood pressure as well as the annual health exam during their early senior years.
  • Remember that a cat ages about 5 years in a year.  Think how much a person changes from 65 to 70 to 75 and 80.  So annual exam with a blood pressure check and blood screening tests is like being examined every 5 years to your cat.  Because of this as our cats age we do phase into an exam every 6 months instead of every 12 months.
  • At this same time we also recommend re-evaluating your cat’s nutritional needs.  Some things we like to try and add are: 1) canned diet if you are not already feeding some canned food – just to increase water intake, 2) Omega 3 oil which is good for the kidneys, heart, brain, skin – well you name it and Omega 3’s help, and 3) Glucosamine  (I use the Therabite treats because they are easy!)
  • And lastly there are subtle changes you want to be on the look out for…

–  Change in jump height, Decrease socialization, Change in attitude – like now is grumpy when being brushed or petted, Inappropriate Urination, Decrease or Increase grooming  – these are just a few possible signs that your cat may be hurting.  For more information check out :

http://www.fvah.ca/2015/05/06/6-clues-that-your-pet-may-have-arthritis/

– Dementia can be another issue we can see in our older cats.  Change in their sleep/wake cycle, increase vocalization, changes in social interactions, inappropriate urination or defection can all be a sign that your cat has some “kitty-Alzheimer”.  Once again trying to catch it early can help as there are things we can do to help and improve quality of life – like using Omega 3 oil.  For more information check out:

http://www.fvah.ca/2015/05/06/dementia-in-senior-pets-it-is-more-common-than-you-think/

–  As our cats age they will progress from senior care to geriatric care.  At what age that occurs? Is a little bit cat dependent just like there can be a fit and healthy 80 year old man or one whose health plaques him.  In general it is in the late teens to early 20’s.  And though we are concerned about quality of life whether we own a kitten or a senior, it is truly in the geriatric cats that it becomes our prime focus when it comes to their health care.

 For more information on senior care check out…

http://www.fvah.ca/2015/05/06/9-steps-to-keep-your-senior-healthy/

http://www.fvah.ca/2016/01/20/five-ways-to-help-your-pet-live-longer/