1.3.18

NMVMA listserve Behavior Tip #30

 

Hi colleagues-

Here is the story of a cat who was sweet at home but scared to the point of serious reactive aggression in the veterinary clinic. I hope you find it helpful.

All the best,
Jeff

 

This is the story of Sherman, a cat who learned to hate going to the veterinarian. This sad turn of events led to serious challenges for this fine kitty.

When I met Sherman he was a sporty little black and white feline youth of about 8 weeks. During my first exam room encounter with him he stood up for himself. I respected his strength of character. I vaccinated and neutered Sherman, events that left our professional relationship unscathed. His family consisted of Bonnie and Rick, a couple of genuinely committed pet parents. Sherman was treated well everywhere he went. He was on his way to an excellent life.

I encountered Sherman from time to time for the usual juvenile bumps and bruises. I always found him to be cooperative and enjoyable. His folks wanted only the best for him, making my job that much easier. Then there was a job transfer to California. I really liked that little family; I was sad to see them go.

One day, about 8 years later, I was surprised to receive an email from Sherman’s mom Bonnie. She was happy to report that she and her husband, along with Sherman, had returned permanently to Albuquerque. This good lady had a question or two about her cat. His appetite had been gradually diminishing and she was concerned that he was losing weight. Bonnie hoped that I could advise her regarding a different diet for her special cat.

Like many caring cat parents in this situation Bonnie and Rick had already tried a PetSmart cart full of savory, tender, gourmet, fancy, yummy, and elegant morsels but Sherman was losing interest in their offerings. Evidence-based medicine requires us to diagnose first and treat second. I explained that cats who lose their appetites aren’t finicky. They’re sick.

Bonnie acknowledged that it had been a long time since Sherman had seen a doctor. It wasn’t that she and Rick didn’t feel that it was important; Sherman just hated going. During his first veterinary visit, after moving to California several years earlier, the staff had taken Sherman to the treatment room for his vaccination booster. His folks heard their boy cry out but he was returned to them in apparently good form. They took him home, unconcerned.

The next time routine care was needed, after a lot of pushing, shoving, coaxing, and cajoling to get Sherman into his carrier, he became intensely aggressive toward the doctor and staff. Trying a different animal clinic the next time brought a near identical result. Believing that cats, especially those living indoors with doting pet parents, don’t really need a lot of preventative care, they gave it up. They had reasoned that cats are pretty adept at managing their own health anyway.

Veterinarians know that cats have as much need for annual exams and preventive medicine as anyone. We are the leaders and teachers on the wellbeing of animals. It’s our responsibility to shift attitudes. Sure, this makes sense. But getting Sherman through a doctor’s appointment was a nightmare. He and his family were not alone; there are a lot of cats and their people who’ve chosen Dr. Google instead of a flesh and blood veterinarian because visits to the clinic are just too stressful.

I told Bonnie that I needed to see Sherman regardless. I could only help him if I figured out what was wrong. When he arrived on my exam table a few hours later it was immediately clear that this wasn’t the vital young kitty I remembered. He was clearly ill.

Not only would he need a thorough exam; serum chemistries, CBC, and a UA would be essential to an accurate diagnosis. If I had one of our nurses restrain Sherman I knew that he would freak-out and fight hard to get loose. His defensive aggression would be even worse the next time. Cats who struggle hard, especially those who are seriously ill, are at risk of sudden death. The prospects of worsening Sherman’s behavioral association with veterinary facilities and putting his life in jeopardy were untenable.

The good news was that at home with his folks Sherman was, well, a pussycat. Bonnie and Rick could do anything with him. I prescribed 100 mg gabapentin capsules and told my clients to add the contents of one capsule to a small amount of food about 2 hours prior to loading their kitty into his carrier for the trip to the clinic.

Back on my exam table the following day I peered through the cat carrier at my laid back patient. Sherman didn’t have a care in the world. It was time to get to work.

Like me, my assistant was trained and certified on the gentle handling of frightened pets. With Bonnie and Rick close by our nurse removed the top half of Sherman’s carrier and then covered his head with a towel. Touching him gently and speaking quietly I palpated his limbs and abdomen, feeling his internal organs for size and shape. I ausculted his chest and checked his lymph nodes. I slowly removed the towel from Sherman’s head and examined his eyes, ears, and mouth.

The use of proper handling techniques and, for historically freaked-out pets, appropriate medications, make it possible for us to safely practice thorough medicine. Not only was the gabapentin causing Sherman to be downright compliant, this medication is also a pain reliever. Drawing blood and urine was quick and easy. We were on a roll.

As Sherman chilled I explained this kitty’s seriously thin body condition to his folks. I also pointed out the accumulation of dental calculus and that his kidneys palpated small. Sherman was 11 years old by this time, which raised the statistical risk of kidney failure to the top of our list of concerns. The opportunity for additional diagnostics was right in front of us. Sherman’s folks, relieved that their kitty was not suffering any stress, gave us the go-ahead.

Slowly positioning Sherman for chest and abdominal x-rays and then an ultrasound evaluation took another 30 minutes. As we ensconced him once again in his carrier he began to shift and grumble just a little. We’d gotten out in time. From his ringside seat our patient’s cat daddy commented that this was apparently “not my first rodeo”. Well, it had most certainly not been a rodeo. It was a rodeo several years earlier that had created this problem for Sherman. I avoided verbalizing that remark and instead thanked my loyal client for the compliment.

The diagnostic process proved valuable. We came to learn that Sherman was in stage 3 kidney failure. This was not a minor problem but the prognosis was good with consistent at-home treatment and follow-up monitoring. Rick and Bonnie were on-board for the duration. I’d known them long enough to be confident that they would do whatever it took.

Treatment for Sherman’s renal hypertension, a kidney sparing diet, and daily subcutaneous fluids bought Sherman several more good years with his family. Prior to every follow-up he was pretreated with gabapentin at home to assure a no-stress exam and lab draw. I was able to do right by Sherman and his folks but I always wondered how much more life he could have enjoyed.

Each of Sherman’s people, Rick and Bonnie, had a full-time career; they’d never had human children. This cat was it for them. They loved him intensely. They certainly would have brought him in for annual wellness exams and routine labs as recommended but for one major problem. With just one serious scare their kitty innately employed the behavioral principle of one-event learning. Members of any species can be classically conditioned to associate a strong emotion-based reaction with a particular context. Cats, like none other, are masters of one event learning. Had Sherman lived to be 30 his terror of veterinary clinics would never have faded.

Cats are wonderful pets but they can be fussy, can’t they? They seem so aloof and independent. They might come when called or maybe not. Those of us who can’t imagine living without cats accept them in spite of those differences and, in some ways, because of them. Cats don’t fully understand us either but they love us anyway. I’ve always believed that my cats set a good example for acceptance.

These creatures have become the most popular pet species in America because, according to cat owner surveys, busy people believe that they’re low maintenance. We need stay-at-home companions who are fine whether we’re there or not. Many devoted cat parents believe that their pets require less medical management than dogs and pretty much care for themselves.That badly flawed notion is widely believed because cats hardly ever complain. (OK, I know a few of them are serious chatterboxes. We’ll tackle that challenge another time.)

Setting cats up for long and excellent feline-specific lives in a human domicile requires a serious understanding of who they are and what they need to thrive. These pets are actually very different than you and I. Sometimes referred to as socially asocial, cats certainly form relationships but they don’t rely on them for survival. Except when caring for their young, cats don’t naturally look out for each other. If they get sick or hurt they don’t cry out to their comrades for aid. Instead they get small and try to power through it on their own.

When cats are well they are predators. But if they’re feeling weak and puny they hide out to avoid being prey. This is not how humans operate but if we’re going to improve the lives of more cats our clients must play the hand they’ve been dealt and manage their cats like cats. Cats are not human wannabees; they’re not little people in furry suits.

I advise educating cat owners on the early indicators of illness. Since they can’t rely on them to limp if their leg hurts or puff and blow if they’re struggling to breathe they’ll need to be observant in ways that are not intuitively human. It’s a different twist on the Golden Rule. Rather than treating them as we would like to be treated we must learn to treat them as they need to be treated. Anything less relegates their wellbeing to dumb luck.

We veterinarians carry a huge responsibility to our patients and the people who cherish them. We are all well-served by a recently developed initiative called Fear Free. Veterinarians, their staffs, pet groomers, trainers, and even pet parents can take the appropriate training modules online. Veterinary professionals can become certified. I am residency trained in the specialty of veterinary behavior medicine. I’m a true believer in Fear Free. I was credentialed early.

We have good methods for helping pets who’ve already learned to react to veterinarians with defensive aggression. But, as is often true in life, avoidance of the initial life-altering event is undoubtedly best for everybody, most importantly the pet.

 

All the best,

Jeff

 

Jeff Nichol, D.V.M.
Residency trained by the American College of Veterinary Behaviorists
Veterinary Behavior Medicine
Albuquerque and Santa Fe

I invite you to peruse and use any of the information from this and past nmvetlist missives. You will find the entire archive on the For Veterinarians page of my website, drjeffnichol.com/