Practice Dilemma: The disbelieving cat owner

It’s the end of a long block of consults, and you’re relieved to see that your last slot is a simple cat booster. “Oscar” is a 12-year-old domestic shorthair and is in great health for his age – he’s bright and alert, no weight loss, eating well, BCS of 5/9, and no changes in drinking or urination. He happily sits in his basket and waits to be lifted out, and then waits again to be lifted back in.

Now, that alone is enough to be a bit of a warning sign with many cats, as usually, they are quite keen to get back inside their carrier after a booster, however cat-friendly we are! In this case, you also recall that there was perhaps a little bit of a flinch when you were stroking his back and hindquarters… but not one that was particularly dramatic.

You are aware that the risk of osteoarthritis in cats of Oscar’s age is very high – with 90% showing radiographic signs (1), and 48% having multiple arthritic joints (2). However, on raising the possibility, Oscar’s owner is disbelieving. Of course, he hasn’t got arthritis – he isn’t limping!

So where do we go from here?

Well, let’s start out with some statistics. Research suggests that only 4-17% of affected cats show clear signs of lameness (1)(3). However, as you observed, more subtle signs are much more common – unwillingness to jump (4) and that characteristic subtle flinch on palpation (5) are classic signs, but easily missed by the owner.

So, a starting point might be to introduce Oscar’s owner to this information – there are a number of good resources around https://yumove.co.uk/blogs/health-guides/getting-the-most-from-yumove-cat

It can also be very valuable to discuss a suitable pain scoring system designed for use in cats with chronic pain – note that the classic Glasgow Pain Scale for Cats does not work as well for chronic osteoarthritic pain as for acute pain states (6). Many of these systems are questionnaire-based and are designed to be performed by the owner. A recent study found that three different instruments (the Feline Musculoskeletal Pain Index; the Owner Behaviour Watch; and the Zamprogno Question Bank) met the criteria for having a “strong linear relationship” with the patient’s clinical status in osteoarthritic cats (5).

Another approach might be to consider an analgesic trial, whilst asking Oscar’s owner to see if there are any changes to his behaviour – although trial use of NSAIDs in older cats does have its risks, especially if renal function is not fully known.

So, sadly, this “easy” booster consult is turning out to be a bit of a nightmare! You need to educate Oscar’s owner, maybe persuade him to do a  seemingly complicated survey at home, and then come up with a plan of action.

The fundamental problem with poor Oscar is that his owner wasn’t expecting this. As far as he was concerned, he had a happy healthy cat, and is inevitably resistant to the idea that instead, Oscar has a significant health issue.

Educating your clients about osteoarthritis in all your routine “middle-aged” cat consults could help overcome this. Advising them on how to spot early signs of osteoarthritis such as an unwillingness to jump, a reduced height of the jump, and/or a slightly stiff gait could prove really helpful (4): Get your clients used to the idea that osteoarthritis is a common problem in older cats and that limping is, in fact, an end-stage sign. Get them thinking about how they can actively support joint health – with weight control, home modifications, and cat-friendly joint supplements which include antioxidants, ActivEase Green-Lipped Mussel, and hyaluronic acid (as found in YuMOVE).

But above all, have those conversations, so when their cat does start showing signs of stiffness or slowing down, they’re ready to come to you straight away for advice and treatment. Feline osteoarthritis is common, and the sooner the signs of this painful condition are recognised both by the owner and the vet, the sooner we can help manage this chronic and often debilitating disease.

References:

(1) Hardie, EM, Roe, SC, Martin, FR. (2002) Radiographic evidence of degenerative joint disease in geriatric cats: 100 cases (1994–1997). J Am Vet Med Assoc 2002; 220:628–32.

(2) Slingerland, LI, Hazewinkel, HAW, Meij, BP, Picavet, Ph, Voorhout, G. (2011) Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats. Vet J 2011; 187:304–9.

(3) Godfrey, DR. (2005) Osteoarthritis in cats: a retrospective radiological study. J Small Anim Pract 2005; 46:425–29.

(4) Clarke, SP, Bennett, D. (2006) Feline osteoarthritis: a prospective study. J Small Anim Pract 2006; 47:439–45.

(5) Stadig, S, Lascelles, BDX, Nyman, G, Bergh, A. (2019) Evaluation and comparison of pain questionnaires for clinical screening of osteoarthritis in cats. Vet Rec Open.

(6) Pelligand, L, and Mora, SS. (2020) “Pain Assessment Methods” in Duke-Novakovski, T, de Vries, M and Seymour, C. (eds) BSAVA Malual of Canine and Feline Anaesthesia and Analgesia, BSAVA, pp. 121-122