Caring for Your Cat From Kittenhood Through Old Age

Analysis by Dr. Karen Shaw Becker

Story at-a-glance -

  • Welcome to day 5 of our Companion Animal Nutrition and Wellness Institute’s (CANWI) Annual Awareness Week
  • Today, Dr. Donna Raditic and I are talking with a very special guest, fellow veterinarian Dr. Sheilah Robertson; Dr. Robertson is a board-certified anesthesiologist, an animal welfare and shelter medicine expert, and also senior medical director at Lap of Love Veterinary Hospice
  • We’re talking all things cats with Dr. Robertson, with a special focus on senior and geriatric kitties
  • Dr. Robertson discusses how to tell if your kitty is hurting and offers a brilliant tip on how to share that information with your veterinarian
  • We also discuss the best ways to reduce stress in cats during vet visits, how to take excellent care of aging kitties and much more

Today, as part of Companion Animal Nutrition and Wellness Institute (CANWI) Awareness Week, Dr. Donna Raditic and I are hosting a very special interview. As most of you know, Dr. Raditic and I co-founded CANWI. Dr. Raditic is also a board-certified nutritionist and has taught nutrition and integrative medicine at University of Tennessee's College of Veterinary Medicine.

Our special guest today is Dr. Sheilah Robertson, who is an incredibly accomplished veterinarian and also has a PhD. She's board-certified in anesthesia and animal welfare in Europe and the U.S. She's a small animal acupuncturist. She completed post-graduate training in shelter medicine and has taught at several veterinary schools in Canada and in the U.S.

She was on staff in the Animal Welfare division of the American Veterinary Medical Association (AVMA) for two years, and is the senior medical director at Lap of Love Veterinary Hospice, which is a large network of veterinarians who provide in-home euthanasia and end-of-life care around the U.S. It's a great organization.

It is Dr. Robertson's passion for creating and maintaining quality of life for animals until the very end of their lives that inspired us to reach out to her. She's talking to us from Scotland, where she grew up. She's there visiting her family.

One of Life's Mysteries: Recognizing When Your Cat Is Hurting

Dr. Robertson has done a lot of research on cats and pain management. As we know, kitties are masterful at hiding disease, and tend to be mysterious in general when it comes to their health.

"That's an understatement," Dr. Robertson agrees. "I swore after my first research project with cats, I was done! And then I was so fascinated I just kept working with them. It's important to remember there's a big difference between acute pain and long-term or chronic pain.

What we're learning is that cat owners are usually the people who know first that something's wrong, because they know their pet best. Most of the clues to a sick cat involve changes in behavior.

If there's a sudden acute type of pain, for example, the pain of a pancreatitis attack or a gastrointestinal (GI) obstruction, when we view videos of cats in acute pain, we see evidence in their facial expressions and posture. A cat with belly pain will be very hunched. Their head will be down and they will look very uncomfortable. Those are all signs something's wrong in the abdomen, in the belly.

Another thing we've learned — actually Charles Darwin was the first to point it out in apes, and he also mentioned cats and humans — is there's a consistent species-wide change in facial expression with pain, because pain is an emotion. Every species, even animals that are predated like mice and rabbits, hide things very well. But the one thing they can't hide, because it's hardwired [versus] learned, is their facial expression when they're in pain.

You know yourself that if you're uncomfortable or in pain, you grimace. That's why it's called the 'grimace scale.' Cats who are uncomfortable clench their mouths, which makes them look tense around the muzzle. And their whiskers move. Normally, they sort of hang down toward the front, but when a cat grimaces, the whiskers pull back and are more horizontal. You can actually see the tension in their face.

Another thing they tend to do is kind of half-shut their eyes. And the change in all those muscles pulls the ears down. Ear position and tension around the eyes, muzzle, and whiskers gives us lots of clues about what's going on, especially with acute pain."

A Brilliant Tip Every Cat Parent Should Consider

These signs of pain in kitties are important signals, but not many veterinarians are pointing them out to their clients. And they really need to, because cat parents should be knowledgeable about the nonverbal cues cats give when something is wrong with them.

"That's absolutely true," Dr. Sheilah agrees. "It's not that cats don't have a language, it's just that it's not our language. I think as veterinarians, it's our duty to learn what they're trying to tell us and show us. Toward that end, the face is very important.

There's some research coming out now about the grimace scale in cats and the pain face. There's a study underway in Montreal right now looking at the facial expressions of cats that have pain in their mouths. We know that mouth pain from stomatitis and inflammation in the mouth is very common in cats. Part of that study is looking at what happens to the facial expression of cats when they have a sore mouth."

Dr. Raditic agrees with Dr. Robertson that veterinarians need to listen to cat parents, because they are the ones most familiar with what their pet's face looks like. They may not have knowledge of the grimace scale, or use the same words to describe what they're seeing, but they know just by looking at their kitty that something's not right.

When a cat parent shares that with us, we run all the diagnostic tests, and if we don't find anything abnormal, we tend to dismiss the owner's concern. What we should be doing is continuing to investigate, because owners know their pets better than we do.

"When cats are brought to the veterinary clinic, they're pretty stressed," Dr. Sheilah points out. "And their stress level will cause them to behave differently in that setting than they do at home. I have found it very helpful when owners take a short video of their cat at home. Nearly everyone has a smartphone, and it's really helpful if they can take a quick video of their cat walking.

For example, cats suffering with arthritis walk differently than healthy cats. If the cat's owner can take a short video of their pet's face, of the cat climbing up steps or into the litterbox, it can be extremely helpful. Those are motions we can't reproduce in the clinic on an exam room table. I've found those videos to be tremendously beneficial in helping me figure out what's going on with a kitty."

I think this is fantastic advice! It could even work in situations where a cat parent is trying to decide if they need to bring kitty into the veterinary clinic. If they can take a short video of the cat's behavior and appearance and send it to the clinic so the vet staff can review it, it could be a great way to decide if they're seeing something that requires a visit.

When It Comes to Your Cat's Health, a Picture Can Be Worth a Thousand Words

"I've had a lot of cats," says Dr. Robertson. "Even with my own cats, as they were getting older and dealing with various health and mobility issues, I used to record a quick video, date it, and put it in a little folder I kept on each of them. Then I could use it to check treatment progress (or lack of progress)."

Dr. Raditic has used this approach as well, with a couple of very cat-savvy clients who have sent her videos of their kitties showing different postures or facial expressions. She feels it's extremely helpful, and it even allows her to consult with clients over the phone when necessary.

Dr. Raditic also points out that a video can be helpful when clients and veterinarians aren't using the same terms to describe a particular facial expression or posture. For example, clients are much more likely to say their cat looks "tight" or "tense," never using the word "grimace." When the vet looks at a video, he or she can actually visualize what the client is talking about, eliminating the lost-in-translation problem.

Dr. Raditic also loves the idea of plotting a cat's progress using short videos. Take a kitty with osteoarthritis, for example. The vet implements a treatment plan that involves weight loss and pain management. How does the vet know if the cat is responding? Progress is much easier to see if there are short videos of how the kitty was moving before treatment, and then after treatment is implemented. Is she looking better, the same or worse? "A picture is worth a thousand words," says Dr. Robertson.

Reducing Cats' Stress During Vet Visits

Next, I asked Dr. Robertson for her recommendations to reduce kitty stress during veterinary visits.

"Obviously, in an emergency situation, the owner can't really prepare to manage the cat's stress," she explains. "But if it's a planned visit, for example, for a dental procedure, we can start helping the cat before they even leave home. I'm trained in anesthesia and owners often focus on what drugs we're going to use.

When I tell them anesthesia starts at home, they're like, 'What?' When I see a kitty who needs to come back for a procedure, I like to send the owner home with facial pheromones, either sprays or wipes, to treat the carrier. It's really easy to do.

Thirty minutes before they leave the house, they spray or wipe down the carrier, which gives the alcohol carrier in the product time to evaporate. I think it's good to leave cat carriers out in the house all the time. I put treats in my cats' carriers and their favorite blanket. When the carrier's always around and accessible, it no longer represents something scary. It's no longer a signal that the cat needs to run and hide.

Another thing that has really changed life for a lot of cats, cat parents, and vet staffs is prescribing gabapentin the night before the visit with a little bit of tasty food. The kitties arrive pretty calm, and their heart rates are more normal.

This allows us to do a better physical exam, which makes things safer, for example, when we deliver anesthesia. Gabapentin is something that I think a lot of veterinarians are starting to embrace. But obviously, that's only when you can plan the visit.

But even when a vet visit isn't planned, what I started doing when I was at Michigan State was to have several towels pretreated with facial pheromones and ready to go the minute a cat arrived. The owners were asked to take the cat to a separate waiting area, cover the carrier with a pretreated towel, and put it up on a high surface.

Our main goal was to get each cat from check-in to a consulting room as fast as possible, and we tried to keep one consulting room for cats only. That consulting room had clothing, a soft table, and even the equipment treated with pheromones.

The worst thing you can do is walk into a clinic and put the cat carrier on the floor. There should always be a shelf or another spot off the floor. It's easy to hang up the towels in the morning, spray them, and let them air out and then fold them up. We used to keep them in a plastic tote. When we saw a cat carrier, it was like, 'Here's a towel. Put your cat carrier up here and cover it. We'll get you into a consulting room as fast as possible.'"

When Is a Cat Considered Old?

Next, Dr. Raditic asked Dr. Robertson at what age she considers a cat to be "old."

"Well, in the year and a half I've been with Lap of Love, the age group of cats I deal with has shifted quite a bit," she answered. "The American Association of Feline Practitioners (AAFP) has good guidelines about age, care of the senior cat, and so on. Many people use the terms 'senior' and 'geriatric' to describe older cats

Geriatric, to me, describes a very frail cat. That's how we use the term in human medicine. It's someone who's frail. 'Senior' is more like they've reached an age where we know certain things are more likely to happen, such as kidney disease, hyperthyroidism and so on.

We do know from studies that over the age of 12, there is a slightly higher risk for anesthesia complications due to the changes that come with aging. But not every cat is geriatric at age 15. There are some cats over 15 that I wouldn't classify as geriatric, because they're still quite robust and doing well.

And then there are some 13- and 14-year-olds who are very frail. I would classify them like an older person who's aged more quickly than the general population. I don't think there's an answer that applies for every cat. You can find charts that say a 15-year-old cat is like a 76-year-old person. We know we have healthy 76-year-old humans, and the same goes for cats.

We do know that at about age 10 we see a sudden increase in osteoarthritis, however, we know that arthritis is a disease that also occurs in some younger cats. Generally speaking, I would say that 10 to 12 is the age at which a lot of things start happening in cats."

Older Kitties Should Visit the Vet at Least Twice a Year

I asked Dr. Robertson how often a proactive cat parent should take an older cat for veterinary visits. It's never a good idea to wait till your pet becomes sick. We want to encourage pet parents to think proactively about creating wellness in their kitties through smart lifestyle choices, which includes regular senior wellness checkups.

"Ideally, we're looking at every six months — twice a year," Dr. Robertson answers. "Depending on the cat's individual health situation, more frequent visits might make sense. Weight loss, especially in older cats, can be very gradual and insidious, and it's not always obvious. I don't think many owners routinely weigh their cats.

Losing even half a pound is significant in a cat, and the owner may not notice because it happens very gradually. The weight issue is really important, because once kitties start losing lean body mass, they can develop sarcopenia and all the issues that go with it.

I also believe we need to start thinking about senior clinics geared towards the older cat. Health screenings and education can be done by trained nurses and technicians during senior and geriatric wellness checkups. Not every visit may require a veterinarian. They're starting to do this in the United Kingdom — have senior cat clinics run by veterinary nurses. If something's picked up during the health screening, the cat sees a veterinarian.

I think if we can help people understand that we can make that used-to-be-stressful visit much less stressful by using gabapentin, by getting kitties used to their carriers, by using facial pheromones, and by the way we handle them in the clinic, I think we would see more cats. As always, prevention is better than cure, and usually much cheaper as well."

Body Composition in Older Cats Changes Rapidly

Dr. Raditic points out there are studies that show kitties 10 years and older have a significant (possibly 30 to 40 percent) reduction in their ability to absorb specific nutrients from their diet, including protein and fat.

"Sometimes even overweight older cats that still look big and fluffy can have things going on below the surface," says Dr. Raditic. "When we palpate muscle or do muscle condition scoring we can see they're losing muscle mass, and muscle weighs more than fat, so there can be dramatic weight shifts.

As a nutritionist, I very seldom recommend weight loss even for overweight cats over a certain age, because there are a lot of changes occurring in the health of those patients.

"I think you're absolutely right, because it's not just their weight," says Dr. Robertson. "It's the change in body composition that's occurring. Studies show there can be a dramatic loss in lean muscle mass in cats, similar to older people with sarcopenia.

As an anesthesiologist, I know blood volume also changes. Muscle mass decreases. There's more fat. The composition of these cats' bodies changes, and those changes can have a dramatic effect on how anesthethic drugs work. That's why cats can get into trouble when they're anesthetized when they're older, because people haven't really thought about these changes in body composition.

I just read a report recently that shows most veterinarians aren't doing muscle condition scores on cat patients — under 20 percent, in fact. It's so important to do both body condition and muscle condition scoring in older cats. We need to record the actual physical weight, the body condition score, and the muscle condition score."

The Importance of Joint Support and Other Dietary Supplements for Aging Kitties

I asked Dr. Robertson if she thinks cat parents should begin adding joint support supplements to their pets' diets before they begin to experience degenerative joint damage. She agreed that diets containing glucosamine, chondroitin, green-lipped mussel and fatty acids are a good idea.

"I think essential fatty acids are important for cognitive function in older cats," says Dr. Robertson. "The quality of the foods and supplements is important, as well as the dosing. As to whether we should give them early or wait until they show symptoms, my feeling is 'sooner rather than later.' Prevention rather than treatment."

I asked Dr. Raditic, as a veterinary nutritionist, what she recommends adding to or changing in the diet of senior and geriatric cats to help address aging-related issues.

"What Dr. Robertson pointed out is very important," says Dr. Raditic. "I always do ratios of omega-6 fatty acids to omega-3 fatty acids. Cats need both 6s and 3s, but most commercial diets are very high in omega-6s. Omega-6s tend to be very pro-inflammatory. Inflammation is a factor in almost every disease process.

In the diets I formulate, I aim for ratios of 2 to 1, or even 1 to 1 by supplementing with more omega-3s. I also agree that glucosamine and chondroitin are important. Perna, the green-lipped sea mussel, is a source of chondroitin, and it may also provide another type of fatty acid that has anti-inflammatory properties. Also, if a cat's kidney situation is stable, I like to have very high-quality protein in the diet and enough of it to maintain lean muscle mass.

We know aging means muscle loss, but I do wonder if we're giving older cats everything they need. It's not so much protein they need but amino acids. If we can provide those amino acid building blocks in the highest quality possible in their diet to maintain muscle mass, then the muscle structures around aging joints can function better."

Cannabidiol for Pain: Still a Mostly Taboo Subject for Veterinarians

I asked Dr. Robertson, as an expert in pain management, if she had experience with cannabidiol (CBD) to treat pain in cats, and what she thinks of it.

"There was an AVMA webcast on this subject a few weeks ago if anyone's interested," she replied. "But in theory, we're not supposed to talk about it. I follow a lot of the human research on CBD treatment and animal research is starting to come out. There's a recently published paper on CBD and the appropriate dose for dogs with OA. It's in a peer-reviewed journal.

What I heard is that just recently in California, they changed the regulations to allow veterinarians to discuss cannabinoids with pet owners. In theory, we can't suggest, discuss, or prescribe. But on the other hand, I don't think it's ideal that we're not supposed to touch on that whole area, because we know owners will go off on their own.

They go to the internet, for example, when veterinarians would be a better resource for them. It's really a catch-22 at the moment. California looks like they've made it okay for vets to talk about it. But I think we need to get good research. We are getting some in dogs. It's not going to be the cure-all for everything, but it has its place in human medicine. I don't know why it should be any different for dogs and cats.

So research is being done, but it's hampered by the fact that CBD is still considered a Schedule 1 drug like heroin, so to actually get a research license and the ability to conduct the research has been very problematic.

Fat on Your Cat Is Much More Than Just a Weight Problem

Next I asked Dr. Robertson for her thoughts on the obesity epidemic in cats, especially in light of the challenges of putting older cats on diets, as Dr. Raditic discussed earlier.

"I think it's a huge issue when you look at the number of obese cats going up and up and up," she replied. "The issue, I think, is that people aren't looking closely enough at the problem. Fat is pro-inflammatory. It's like a pro-inflammatory factory in the body. That's the problem.

Everyone thinks, 'Well, it's just fat.' But that's not the case. There are pro-inflammatory mediators coming from the fat that are dangerous. It's not just that the cat's overweight and putting excess stress on the joints. It's also a higher level of circulating pro-inflammatory soup in their bodies.

Kidney disease in cats is really different from kidney disease in dogs. Something like 68 percent of cats diagnosed with osteoarthritis also have kidney disease. Is there a link? Is it inflammation? The fact that they've been overweight their whole lives can't be a good thing. I think we haven't focused enough on this source of inflammatory products that come from fat.

Ideally, we'd like to start out right with kittens and make sure they never get overweight. But right now we have millions of overweight cats. And when they're senior or geriatric, it's tough, because they need high-quality digestible protein to maintain muscle mass. It gets to be quite tricky.

I know it's very hard, unlike with dogs, to increase activity levels in cats. But if the owner is willing, then I think there are ways it can be done. But they really need to be willing. Cats were never meant to eat once or twice a day. That was never their lifestyle. They were meant to be hunters and hypercarnivores.

I do it with my own cats. Their rations are hidden all around the house. I think we need to feed them more frequently in small amounts during the day. I started using lots of food puzzles. One of my cats is overweight. It worked great for him, because he just couldn't be bothered working for the food.

His ration was in there, but he was like, 'Ugh. That's too much work.' So he lost weight. I think the puzzles are also good for cognitive enrichment. It takes a lot of time to get the food out, so it keeps their minds engaged.

I really think food puzzles and hiding food around the house, if owners are willing to do it, are very good. And it's also important to interact with your cat. You might have to get a new toy or a new game every few weeks, but they will help to increase your cat's energy output, sometimes with a little coaxing.

My overweight cat had degenerative joint disease and I actually took him in for treadmill sessions at the rehab center. Believe it or not, the treadmill was underwater. It went well. It doesn't always go well, but it does with some cats. It's the same with acupuncture. People tell me, 'There's no way you're going to stick acupuncture needles in a cat.' That's not necessarily true. Some of them really like it."

Research Into Feline Health Is a Huge Area of Opportunity

This week we're focusing on research. The mission of CANWI, the organization Dr. Raditic and I co-founded, is to conduct university-based, unbiased research that we can share with the world to help pet parents take better care of their animals. I asked Dr. Robertson what areas of research she thinks would be most impactful in improving cats' quality of life.

"There are lots of detailed longevity studies in dogs," she replied. "They're not as detailed or as common in cats. However, there's a university in the U.K. that is taking on PhD candidates who are studying longevity in cats. They're looking at cats in a clinical environment from a young age. The project is going to take 10 years, so it will be a while before we see the results.

I also know there's some amazing work coming out on degenerative joint disease from the group at North Carolina State College of Veterinary Medicine headed up by Dr. Duncan Lascelles. They're looking at new ways of approaching the disease in cats and looking at it as a cat-specific disease. I think that's important.

There's a group in Montreal doing some very good work with joint disease in cats. Of course, if some of these diseases are going to be treated pharmacologically, the key thing is looking at how the drug is metabolized before we even go down that road. Cats are highly sensitive to some drugs, as we know.

For example, carprofen has turned out to be a fantastic [nonsteroidal] for long-term use in dogs, but it's completely inappropriate for cats, because of the pharmacokinetics. I think we should be choosing the right pharmacokinetic profile before we even go down that road, looking for a drug. We're looking for drugs that have oxidative pathways, so we don't run into toxicity problems.

Another thing I would like to see is research on adjusting dose levels in cats based on the health of their kidneys. We know in humans we have to adjust either the dose or the dosing interval based on the person's kidney function. We have some of that data on just one drug in cats, gabapentin.

As far as I know, we don't have much information on other drugs. We need to know how to adjust medication doses/dose intervals in cats based on their kidney and liver function."

Do Cats Develop Metabolic Syndrome Like Humans Do?

We have a lot of work to do when it comes to supporting our feline friends.

"We certainly do," agrees Dr. Raditic. "One of the things that fascinates me is I think there's a parallel in overweight cats to what we know in humans as metabolic syndrome. Diabetes, hypertension, joint disease, cardiovascular conditions — I think cats (and dogs) have their own form of metabolic syndrome, which does involve the pro-inflammatory state of fat mass, or fatty tumors.

I think we really need to connect those dots so we can understand the importance of feeding our cats better, so they don't get overweight, can maintain lean body mass longer, and don't enter a pro-inflammatory state that drives disease."

"Many things revolve around inflammation," agrees Dr. Robertson. "When a human or an animal has a surgical procedure, the inflammatory response from the surgery is significant, but the inflammatory response in obese people and animals is much greater. That's why they have a harder time recovering.

It's not just that they're obese. They have a massive inflammatory response to trauma or surgery. It's been my observation that lean cats bounce back quicker. I'm sure it's the same with humans."

Wow! We should probably think about raising funds for a corollary study of metabolic syndrome in people and cats. This conversation has been insightful and inspiring! Many thanks to Dr. Robertson for taking time out of her busy schedule to join us and provide tons of great information to our listeners, readers and cat parents who want to provide better care for their kitties.

"If you get me started on cats, there's almost no stopping me," says Dr. Robertson. "It was nice to chat with two other people who feel the same, as well as all your cat-loving listeners out there!"