Dr. Nichol’s Blog – Feline Fear & Loathing in the Veterinary Clinic

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 better. 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, her husband, along with Sherman, were returning permanently to the Land of Enchantment. 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 a doctor to diagnose first and treat second. 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 in California, several years earlier, the staff had taken him 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. Cats are pretty adept at managing their own health anyway, aren’t they?

Actually, cats have as much need for annual exams and preventive medicine as anyone. As they age their problems can advance faster, making twice yearly exams the best way of catching problems early enough to make a difference. 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 it’s 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; blood and urine tests 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. Moreover, cats who struggle, 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 a safe antianxiety medication, called gabapentin, at a generous enough dose that Sherman would be relaxed and actually a bit sedated the next time I saw him. 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.

I had already coached my assistant on the gentle handling of frightened pets. With Bonnie and Rick close by our veterinary 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 listened to his heart and lungs 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 can permit us to practice thorough medicine. Not only was the gabapentin, given at home 2 hours earlier, 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 tartar that was caked on his teeth and that his kidneys palpated smaller than normal. Sherman was 11 years old by this time, which raised the statistical risk of kidney failure to the top of our list of priorities. The opportunity for additional diagnostics was right in front of us. Sherman’s folks, relieved that their kitty was not suffering any stress, gave 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.

Oral medication to control Sherman’s blood pressure, a special kidney sparing diet, and daily under-the-skin fluids (cats accept this remarkably well) bought Sherman several more good years with his family. Prior to every follow-up he was pretreated with antianxiety medication at home to assure a no-stress exam and lab draw. We did a good job for Sherman and his folks but I always wondered how much more life he could have enjoyed.

Each of Sherman’s folks had a serious 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 no other species, are masters of one event learning. Had Sherman lived to be 30 his terror of veterinary clinics would never fade.

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. Even with my specialized training and experience I often wonder what they’re thinking. 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. Cats require less medical management than dogs and pretty much care for themselves.

Really? No, not really. 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 they are well they are predators. But if they’re feeling weak and puny they get small to avoid being prey. This is not how humans operate but if we’re going to have feline companions and treat them well we’d better play the hand we’re dealt and manage our cats like cats. Cats are not human wannabees; they’re not little people in furry suits.

So how can you know if your cat is sick or well? Since you can’t rely on them to limp if their leg hurts or puff and blow if they’re struggling to breathe you’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. Fear Free certified veterinary facilities are the best. Look for the logo on their websites.