Complete Care for Your Aging Cat

by Amy Shojai

  Wouldn’t the proper nutritional antioxidant mix also protect the brain,

  and keep cats “thinking” young? Yes, says Debbie Davenport, DVM,

  an internist and director for special education for Hil ’s Pet Nutrition. In

  fact, a diet for dogs developed by Hil ’s does just that. It contains a mix

  of antioxidants, along with other nutrients such as folic acid and L-

  carnitine. Studies at University of New Mexico, the University of

  Toronto, and in-home tests with dog owners have shown that

  Prescription Diet Canine b/d improves learning ability and alertness in

  older dogs, significantly reduces house-soiling accidents and

  disorientation, and improves sleep patterns and interaction with

  owners. Researchers found that cognitive ability in these old dogs

  also improved when their brains were “chal enged” with new things to

  learn.

  It is believed that aged cats with similar cognitive dysfunction may

  also benefit from antioxidant-enriched foods and keeping their minds

  agile. “We’re not nearly as far along with the feline product as we are

  with the canine product,” says Dr. Davenport.

  The difficulty is twofold: first, it is hard to find a large enough number

  of cats of the appropriate age to participate in feeding trials, she says.

  Second, researchers historical y have used dogs, and aren’t sure how

  to devise appropriate cognitive tests for felines and train the cats to

  perform them.

  There simply haven’t been as many studies of cognitive disorder in

  cats as in dogs, says Kel y Moffat, DVM, a veterinarian at Mesa

  Veterinary Hospital in Mesa, Arizona. “They’ve looked at brain

  changes, and they’ve found some that cats seem to have the beta

  amyloid deposition that are similar to the dog or people that are

  showing [Alzheimer’s-like] behavioral signs.”

  Dr. Moffat col ected data from 150 cats over the age of 11 (some

  as old as 21) to track age-related cognitive changes. A similar study

  was conducted by Melisa Bain, DVM, at the University of California-

  Davis. Results support many veterinarians’ opinion that aged cats do,

  indeed, suffer from similar senility problems as aged dogs.

  The onset appears to happen later (since most cats are longer-lived

  than dogs), and also may develop less frequently in cats than in dogs.

  But that may be a perception difference on the part of owners, says

  Dr. Moffat. “Dogs know a lot more commands, and I don’t think we

  hold cats to that,” she says. Dog owners may therefore notice the dog

  “forgetting” a command more readily than cat owners noticing a more

  subtle behavior change.

  Along with a better understanding of feline senility problems is the

  availability of new treatments that may reverse some of the symptoms.

  Drugs such as Anipryl have been used successful y in both dogs and

  cats with the problem.

  Drug Research

  New drugs become available al of the time, and those designed for

  treating old-pet health concerns are at the forefront of veterinary

  research. However, testing and approval of new medicines take a

  long time and great expense, and some never reach veterinary

  approval. Medications that might also be used for humans receive the

  most research funding. Therefore, veterinary medicine commonly

  “borrows” from the human pharmacy to offer a wider range of

  treatment options to aging cats. When a drug has not been official y

  approved for use in pets, it is referred to as “off-label” or “extra-label”

  use.

  A drug does not necessarily need to be official y approved for

  veterinary use. For example, the drug deprenyl, also known as

  selegiline (brand name Anipryl) is approved for dogs suffering from

  cognitive disorders to help reverse the signs of canine senility.

  Although not approved for feline use, the drug has been used safely

  off-label and helped a percentage of cats with similar symptoms.

  Another example is heart medications used to treat common aging-

  heart conditions. ACE-inhibitors (angiotension-converting-enzyme)

  such as Atenolol block nerve receptors on the heart and blood vessels

  to correct the irregular heartbeat caused by disease. Cancer drugs for

  cats are almost always the same ones used in human chemotherapy

  treatments, as are most intravenous fluids, antibiotics, and many of

  the pain medications.

  “In the veterinary market we can prescribe anything we want to,”

  says Dr. Myers. “Off-label use is very important for veterinarians. We

  have to be sensible about it,” he says, “It’s not something you should

  abuse, but we can prescribe al sorts of things that physicians cannot.”

  The FDA al ows veterinarians to prescribe medication in

  circumstances that it’s needed, as long as they explain to the owner

  that the drug is being used off-label, what the side effects may be, and

  how it wil help.

  Clomicalm and Reconcile

  Separation anxiety has long been recognized in dogs, and the

  drug clomipramine (Clomicalm®) has been FDA approved to treat

  this problem. It’s currently also used in humans to treat panic and

  anxiety disorders. It works by inhibiting the re-uptake of serotonin, one

  of the neurotransmitters in the brain associated with good moods.

  Separation anxiety has only recently been recognized in cats, and

  older pets tend to more often suffer from this condition. Clomicalm is

  already being used off-label in cats for feline anxiety disorders and

  aggression with some success.

  The pet version of Prozac ™ was released by Eli Lil y under the

  brand name Reconcile™. The drug fluoxetine has been used in many

  animal behavior issues: inappropriate urine marking in dogs and cats;

  separation anxiety; compulsive chewing; circling; self-mutilation; and

  even aggression.

  Herbal Options

  Herbs have been used for centuries as medicines in both human

  and animal health. “Herbs are very good at helping to stabilize failing

  systems,” says Dr. Beebe. “Chinese herbal medicine is real y good

  for geriatric animals because it has minimal side effects.” Old cats

  that already suffer from cancer or failing kidneys, for example, have

  greater difficulty handling the more powerful Western drugs because

  they must be processed through the kidneys and liver.

  Herbs not only treat the problem, but also have the ability to tonify

  (strengthen) ailing systems. Very few herbs have been through safety

  or efficacy tests, though, and only a handful has any sort of FDA

  endorsement at al . In effect, one could say that all herbs are used off-

  label, and the best ones for feline health care have been proved by the

  test of time.

  The majority of herbs have a very large margin of safety, but they

  are not benign. “If they were, they wouldn’t be causing an effect, and

  what good would they be?” says Dr. Beebe. Keep in mind, too, that

  just because an herb is “natural” does not necessarily mean it is safe.

  For example, pennyroyal has often been touted as a topical flea

  repel ent but it can also cause spontaneous abort
ions in cats. While

  St. John’s wort is used as a natural sedative, it also can cause

  photosensitization and make the cat more susceptible to sunburn.

  Some herbs may cause dangerous drug interactions when used with

  other medicines. For instance, Ephedra sinica used as a

  decongestant can be very dangerous for pets (or people!) with heart

  conditions.

  Herbs are not regulated in the same way as commercial drugs.

  Different manufacturers may offer the same herb products, but one is

  several times stronger than the other. Some consumer investigations

  into “natural” products indicate that without regulation, it’s difficult to be

  assured the labeled ingredients are real y in the bottle. Therefore, you

  must enlist the aid of a veterinarian knowledgeable in their use, of

  their interactions with other drugs, of the reputation of various

  their interactions with other drugs, of the reputation of various

  manufacturers, and with the individual animal’s problem to choose the

  correct herbal treatment.

  Pain Management

  Cats do not react to pain in the same way that people do. Many

  cats suffer from conditions associated with chronic pain, such as

  dental disease, osteoarthritis, interstitial cystitis and cancer. The

  incidence of these painful conditions is more common than we once

  thought, particularly in older cats. Typical y, cats simply hide and stop

  moving when in pain, and become very good at hiding any discomfort.

  For this reason, until relatively recently cats weren’t thought to

  experience pain to the same degree as humans. Yet managing pain

  effectively is at the heart of maintaining a good quality of life for aging

  cats.

  Part of the problem is that cats do not metabolize common pain

  medicines such as NSAID (nonsteroidal anti-inflammatory drugs) in

  the same way as people and dogs. These can be toxic to cats. So

  even when a veterinarian knew a cat was suffering discomfort, she

  didn’t always have good options to help relieve the pain. For instance,

  Rimadyl is one of the newest drugs approved specifical y to address

  arthritis pain in dogs. “A lot of the nonsteroidal anti-inflammatory drugs

  are tricky in cats,” says Susan Little, DVM, a feline specialist in

  Ottawa, Canada. “I don’t use Rimadyl in cats, some people do. But

  you’re always running the risk of adverse reactions.”

  The Companion Animal Pain Management Consortium, launched in

  early 2001, was established to study and better understand the

  mechanisms and treatment of pain. Pfizer Animal Health supported

  the development of regional “pain centers,” created at each of the

  veterinary schools at University of Tennessee, University of Il inois,

  and Colorado State University. Veterinarians in a variety of disciplines

  —oncology, orthopedics, anesthesiology, ophthalmology and others—

  seek to help pain in various ways. At Il inois, anesthesiologist Wil iam

  Tranquil i, DVM, says each group has been asked to identify their

  three most prevalent pain issues, and share their expertise. He hopes

  that this wil help them learn better ways to al eviate pain.

  Experts recommend using several pain management therapies

  (multimodal analgesia) which has a better chance of greater pain

  relief than a single therapy alone. Therapeutic approaches for

  managing chronic pain in cats include: weight management, NSAIDs,

  non-traditional analgesics and adjuncts (e.g., gabapentin, tramadol,

  amantadine), chondroitin-type agents like Adequan®, Omega-3 fatty

  acids and “Joint diets”, acupuncture, physiotherapy, stem-cel therapy,

  and laser therapy.

  Owners must be involved in the process as wel . “We suggest that

  practitioners give owners a chart for them to track how the animal is

  behaving before and after medication to determine what changes they

  see,” says Dr. Tranquil i. For instance, maybe your cat asks to play

  with a fishing-pole toy more often, or once again runs to dinner when

  kibble hits the bowl. “It gives a tool to the owner that encourages them

  to actual y pay attention to what’s going on, on a daily basis, and see if

  things are getting better with medication.”

  Eventual y, the consortium hopes to gather the information into a

  formal pain management program that can be shared with other

  universities, large referral practices, and at veterinary conferences. It

  is hoped that pain management might someday become a new

  veterinary specialty. “Just like we now have pain physicians, we may

  have veterinarians specializing in pain management in the future,”

  says Dr. Tranquil i.

  Comfort Zone

  Harp music has been used in human medicine particularly in

  hospice situations, to al eviate pain and distress. Susan Raimond, an

  author, music therapist and concert violinist and harpist, lectures with

  the International Harp Therapy Faculty in Richmond, Virginia. She has

  been a pioneer in harp therapy for animals.

  Music, especial y from the harp, lowers heart rate and blood

  pressure, slows respiration, increases endorphin levels (natural pain

  control factors produced in the brain), and possibly increases

  longevity. Add harp music to your pet’s environment as a stress

  reliever and pain modulator, or simply to improve his quality of life. It

  wil help you feel better, too!

  Acupuncture

  Acupuncture is now an integral part of veterinary medicine,

  endorsed by the American Veterinary Medical Association, says Dr.

  Beebe. Veterinarians can be certified by IVAS, the International

  Veterinary Acupuncture Society, or by the American Academy of

  Veterinary Acupuncture (AAVA) to ensure they have the proper

  training for animals.

  Acupuncture employs an ancient method for relieving pain without

  the side effects of drugs. Typical y, long, thin needles are inserted into

  the body to stimulate certain points that affect various systems of the

  body. Acupuncture was developed in ancient China and has been

  used for several thousand years to successful y treat a wide range of

  health problems in both people and animals.

  “Al the mechanisms of acupuncture are not understood,” says Dr.

  Beebe. Traditional Chinese Medicine (TCM) holds that al living things

  contain an energy flow cal ed qi (pronounced “chee”) that moves along

  specified pathways (meridians) throughout the body. The meridians

  connect to al the organs, skin, muscles, and nerves, and il ness is

  described as an interruption or imbalance of this natural flow.

  Acupuncture corrects the imbalance and returns the cat (or person) to

  health by stimulating specific points found throughout the body along

  the meridians. Each point is associated with a particular body system.

  Magic? Not at al , although it does sounds odd when we’re more

  accustomed to giving drugs to fix a problem. MRI (magnetic

  resonance imaging) tests have shown that a needle inserted in one

  part of the body somehow does have an effect on other areas. Certain

  parts of the brain light up during acupuncture, when measured using

  an
MRI. For example, needling the outside of the foot (the part

  associated with the eyes) causes the same reaction in the brain as if

  the eyes saw a flash of light.

  “Stimulating specific points on the body can cause the release of

  certain chemical factors in the blood,” says Dr. Beebe. Studies have

  shown that acupuncture stimulates the release of natural painkil ers

  cal ed endorphins, can reduce nausea, and even can affect heart rate

  and blood pressure.

  Holistic veterinarians believe acupuncture helps the body heal itself

  by stimulating circulation, relieving pain, and improving organ function,

  especial y the failing organs of older animals. Many times a cat

  benefits most from using the best applications from each world. “If you

  have a system of medicine that does not cause harm, that is relatively

  free of side effects, and could potential y save a life, you don’t have to

  believe in it or understand al of it,” says Dr. Beebe. “A good doctor

  always offers al the options.”

  Surgery

  Kidney disease and chronic renal failure is one of the top causes of

  death in old cats. When they are healthy otherwise, cats with kidney

  failure benefit from an organ transplant. Kidney transplantation is

  available at University of California-Davis, University of Pennsylvania,

  University of Wisconsin and a few other veterinary specialty centers.

  Hemodialysis is also extremely beneficial and becoming more

  available, says Larry Cowgil , DVM, an internist at University of

  California-Davis. Acutely damaged kidneys may have the ability to

  regain function, if given enough time to heal, and dialysis gives them

  that time. Dialysis temporarily takes the place of the kidneys and

  cleanses the blood of toxins. Dr. Cowgil began the pet dialysis

  program in the early 1990s, and today they are able to treat any pet

  bigger than two kilograms. “The program has grown and grown,” he

  says. “We now have a second unit opening in San Diego at the

  University of California veterinary medical center.” Other programs are

  available across the country, including one at the Animal Medical

  Center in New York and Tufts University in Massachusetts.

  Other senior cat care advances include surgeries to treat chronic

  constipation problems (megacolon); cancer surgeries that remove

  brain tumors; orthopedic procedures that restore function to arthritic