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Cats as patients

What is a cat? Why does it behave as it does, why does it sometimes seem more difficult to deal with than a dog, and how does this affect those working with cats?

In this section we will explore how cats behave in a veterinary clinic, how vets and nurses can predict this, as well as looking at what owners often misunderstand about cats. For cats, stress not only affects the reliability and interpretation of many clinical tests, it is also strongly linked to manifestations of disease and response to treatment. Their home environment can also affect the care the clinic is trying to give.

A cat can be summarised as:

  • A hunter and an obligate carnivore which catches and eats small regular meals
  • Territorial
  • Strongly affected by scents and odours in its environment
  • Self-reliant, emotional and highly aware
  • Influenced greatly by early experience
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A hunter and an obligate carnivore

The cat has evolved physically and behaviourally as a specialist hunter of rodents and other small prey. It is a predator at the top of the food chain and is motivated to hunt by the sight, sound and smell of prey. In order to be a successful hunter the cat will search its territory (its hunting range) at times when its main prey are active and vulnerable – usually at dawn and dusk. As an obligate carnivore, the cat is unable to survive or thrive without a number of nutrients found only in meat.

What does this mean for veterinary clinics?

  • As well-adapted predators, cats are highly efficient at defending themselves against perceived threats. The risk of potential infection from bites and scratches can be high, so it is important to avoid conflict by finding ways to minimise fear and defensive
  • Nutritional imbalances which can have severe or fatal consequences can occur in cats whose owners feed inappropriate diets, such as vegetarian or dog food.
  • Differences in hepatic enzyme pathways make cats vulnerable to the toxic effects of certain drugs or chemicals that they cannot effectively metabolise, and may not affect dogs in a similar

Clients may misunderstand that:

  • Cats cannot be vegetarians no matter what their owners’ desire or ethical beliefs may be. Owners need to understand that being obligate carnivores means that cats have unique and very special dietary
  • The strict dietary requirements of cats are actually extremely difficult to achieve properly with home-prepared diets, and feeding high quality commercial foods (such as the Royal Canin range of cat foods – com) offers the best and safest option to meet their needs.
  • Different life stages of cats have different nutritional requirements and these are best met by diets specifically designed for these
  • Kittens develop hunting and attacking behaviour as they However, if they are encouraged to play roughly or to attack hands and feet during play, this may continue as they grow into adults, and can result in painful and sometimes dangerous human injuries.

Designed to catch and eat regular small meals

For cats in the wild, feeding is a purely functional behaviour and the hunting and capture of prey is time-consuming. As a result, cats are designed to take in small amounts of food frequently throughout the day, and sometimes night as well. Typically, in the wild, cats will consume between 10 and 20 small meals throughout each day and so, neither fixed meal feeding nor providing constant access to food, is probably ideal. Food is the ultimate survival resource for cats. Given the choice cats will search, acquire and consume their prey in solitude and, with the exception of mothers providing opportunities for their kittens to learn prey handling techniques, the feeding process is not a socially interactive one – cats prefer to eat alone. The self-regulation of food intake can be disrupted for owned cats both by neutering and by being kept in an unnatural environment with altered feeding habits. Understanding natural drinking behaviour can also help ensure the cat drinks enough. In the wild, cats consume prey with relatively high water content. However, supplemental water is still needed and cats will generally avoid drinking from water next to where they feed, presumably to avoid water contaminated with spoiled meat.

What does this mean for veterinary clinics?

  • Obesity can be caused or aggravated by owners misunderstanding feline eating
  • Feeding dry food can have a positive impact on dental health, and will allow greater opportunities for more interactive
  • Cats fed only dry food will have a lower dietary water With certain disease conditions, increasing water intake is important and can be helped by feeding wet food.

Clients may misunderstand that:

  • Unlike people, cats are not ideally suited to just one or two large meals a Feeding some or all the food as dry kibble provides easier opportunities to feed multiple small meals and to offer interactivity through hiding kibble, using puzzle feeders/balls/toys etc. This adds valuable stimulation for the cat as well as avoiding unnaturally large and infrequent meals.
  • Cats often eat a small amount of food, and then walk away, as they do not naturally eat large meals. If cats do not eat all their food, this may not necessarily have anything to do with palatability of the diet or being Replacing the food with an alternative that the owner hopes will be more palatable often initially results in increased food intake as cats are generally neophilic (ie, enjoy new foods), but the same pattern often begins again. This type of feeding pattern may also lead to obesity.
  • For cats, feeding is not a socially interactive Behaviours such as leg rubbing and vocalising are actually signals of initiating social interaction, rather than signs that a cat is hungry. A cat can quickly learn that it can use these behaviours to control the food supply. As owners derive pleasure from the interaction with their cat, they will often increase the amount of food offered as a way of rewarding the social interaction (or simply to keep the cat quiet!). This can easily lead to a risk of overfeeding and subsequent obesity.
  • Cats prefer to eat A house with lots of cats needs lots of feeding places so that each cat can get to food freely, quickly and on its own. A willingness by cats in the same household to come together at feeding times is often taken as a sign that they get along well with each other. However, food is a vital survival resource and, as the supply of food is controlled by owners, making it available at certain times and places, cats may have to share space to gain access to it. Cats may suspend hostility for long enough to eat their meal, but the level of tension between the cats at other times may actually increase.
  • The placing of food can be important – putting it in a corner can make it difficult to access; next to a cat flap can be threatening because other cats can come in; next to a glass door can lead to rapid eating in order to get away from a vulnerable position; and next to a noisy appliance may be very threatening for a
 

Territorial

We often use the term ‘territory’ quite loosely, but in behavioural terms it is the area that a cat is prepared to defend. The territory is a bit smaller than the ‘home range’, which is the area the cat normally uses. These are not fixed zones but grow or decrease according to needs and demands. In the wild, the cat’s survival and hunting success depends on the integrity of its individual home range and territory. Consequently cats are usually cautious and concerned about intrusions into their area. As pets, cats are fed by their owners, and they don’t need to hunt to survive. However they still have a strong drive to hunt, and a strong need to establish territories and ranges. Even in a domestic environment, territoriality can strongly influence cats’ behaviour. Disputes occur between competitive individuals over scarce resources and rights of access to resources. Additionally, members of the same household may compete over territory, as cats living in the same property often do not represent a cohesive social group. Understandably for species survival, reproduction is important. Male (tom) ranges are normally much larger than female (queen) ranges (usually from 3 to 10 times). For example, the territory of a typical suburban household female cat is normally her garden and just a bit more. An entire tom though, will range across a number of adjacent gardens. Urban living feral cats that have a plentiful supply of food can tolerate living at a relatively high population density of 75 or more per hectare. Pet cats in a similar urban setting often live at a density of over 120 per hectare. In domestic homes cats are fed on a regular basis and this indoor world becomes their safe core area within their territory. They cannot have a complete view within the house and outside at the same time so, just like their wild ancestors, they scent mark. Cats will use a range of methods to mark their territory, for example, rubbing, scratching or spraying urine, the method being determined by the purpose and their emotional state.

What does this mean for veterinary clinics?

  • Clients may come in for advice because their cat is highly territorial and aggressive towards other cats within their neighbourhood. These very territorial cats seem to actively seek out territory defended by others and try to restrict usage by other cats at certain times, or try to drive them out They may even enter houses, located over a wide area, attack the resident cat (and the owners if they intervene) and spray surfaces with urine to mark them before departing.
  • Clients may come in frequently for treatment for their cat because it is the victim of such a territorially aggressive As well as physical injury, this can include stress related conditions such as feline idiopathic cystitis; conflict between cats in the same household is a common stress trigger.
  • Cats feel unsafe just by being out of their territory; the smells, sounds and sights of the clinic will add to this, making cats very anxious, fearful and

Clients may misunderstand that:

  • Cats are often more bonded to their territory than to their owners – this can lead to a cat returning to an old home if the new home is only a short distance
  • Cats do not necessarily tolerate other cats in the same house. While owners may feel their cat is lonely and needs a ‘friend’, cats may feel very threatened by this as they are not related or from the same social group Visitors who bring their cat to stay can cause great upset to a resident cat.
  • Cats may feel threatened, fight, or try to hide because of threats to territory; they may avoid going outside – owners may be unaware of the perceived threat, which can result in behaviour changes or stress-related
  • Modern cat flaps allow owners a significant degree of control over their cats; however, they may also allow other cats to enter the Ideally cat flaps should allow only the resident cats to enter (eg, by using magnetic, electronic or microchip ‘keys’). The cat flap is a transition point between the safe inner ‘core’ of the cat’s territory and the riskier outside world and for some cats the core territory will only be a small part of the home.
  • If a cat’s territory is limited (eg, when it is confined indoors), the owner needs to ensure that the environment stimulates the The core area of an indoor cat’s territory may be under the bed, and areas around the door may not be seen as safe. Additional resting places high up can increase the safe possibilities of the territory.
  • Some territorial scent marking, when it occurs inside rather than outside (ie, spraying, urination, defecation and sometimes scratching) can be a sign that a cat does not feel safe in the
  • Cats rarely voluntarily leave their home range, so when it is necessary owners need to be sensitive to their needs – for example, choosing a cattery that meets the behavioural needs of the cat, or a cat friendly clinic with staff sympathetic to the cat’s needs and

Highly sensitive to scent

Cats use scent as a means of social communication – usually to keep other cats at a distance (except when looking for mates or scent marking their core territory, or perhaps members of their feline group). Cats use pheromones and scent derived from glands over the face and body as well as urine and even faeces in different circumstances.

Cats have scent glands around their lips and chin, the top of the head, at the base of the tail, in between the digits of their paws and around their anal region. When a cat rubs around its owner it is these areas that leave its unique scent.

Similarly cats mark in the same way on twigs, branches and other objects in their territory. Cats will also claw on trees and fences leaving both a visual and scent mark from glands between their paw pads. The urine of an entire tom cat leaves a pungent smell.

All cats irrespective of gender and neutering status perform scent marking, including spraying. The frequency and pattern of urine spraying can be complex. Cats may also leave faeces uncovered and prominently sited (middening) rather than bury them as another form of scent marking.

‘Natural’ groups of cats, as found in feral or farm colonies where abundant food resources exist, are generally friendly societies where bonds between individuals are demonstrated by mutual rubbing and grooming within the group (and the females may cooperate in terms of pooling kittens). By rubbing against each other the cats exchange their scents to produce a group scent profile; therefore, cats can recognise each member of their social group by how they smell. There is very little aggression within a naturally formed group; however, if cats from outside the social group trespass or try to hunt on their territory, colony members (usually all related females) may show extreme aggression to get rid of these cats as they represent a threat to food and other resources.

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What does this mean for veterinary clinics?

  • ‘Problem’ behaviours involving marking can be common but it can take time to investigate and advise clients Referral to (or advice from) a behaviour specialist should be considered if basic management advice produces no change. Urinalysis is important to help rule out medical problems in cases of inappropriate urination.
  • There are no familiar smells in the clinic so anxiety may be
  • Washing hands and table wiping between patients is essential for hygiene but also to remove the scent of other
  • Hospitalisation in the clinic may be less stressful if the owner can bring in bedding the cat sleeps or rests on at home, and is therefore impregnated with its own scent. This is also good useful advice for bedding in cat
  • Use of synthetic feline facial pheromone can be helpful in both the home and clinic
  • The scent of strong disinfectants can be overwhelming – rinse after use in a cage and allow it to dry before introducing a cat to the

What can this mean in terms of client misunderstanding?

  • Odour is the first sense used to assess food – if food doesn’t smell palatable the cat won’t even attempt to taste it. Diseases such as upper respiratory tract infections compromise the sense of smell, and cats may not wish to Using high fat foods and releasing odours by warming the food to body temperature can make it more tempting.
  • Changes to the familiar and reassuring scent profile of the cat’s home can be challenging, for example, household cleaners and deodorisers, new furniture, visiting people or dogs, other cats coming in through the cat flap, decorating, etc. It is important to understand changes in the cat’s environment if there are reported behavioural
  • Scent marking indoors is not a sign that a cat is ‘dirty’ but is a response to changes in emotional state and often happens when a cat feels This might be in response to a new cat or some change in the environment that a cat finds challenging.
  • Owners often misinterpret spraying for inappropriate elimination and vice

Naturally ‘clean’

Cats spend around 4 per cent of their life (or 8 per cent of their non-sleeping time), grooming. The drive to groom is very strong. Cats are predators – they need to remain in top condition to hunt and to stalk prey, so maintenance is important. Grooming helps to remove parasites and anything that may degrade and smell on the coat. The hairs in the coat are also highly sensitive to movement and so help to give the cat information about its surroundings, wind direction, etc. Grooming is also involved in maintaining social relationships and is likely to serve as a comfort behaviour. Because of their fastidious nature, cats may groom poisonous substances from their coat that they have been exposed to, and which they would never otherwise directly eat or drink. While urine and faeces can be used for scent marking, cats may also wish to conceal their whereabouts by burying them. For humans the cat is usually an exceptionally pleasant animal to have around in that it does not smell to us and will usually use a litter tray very successfully if required (it is up to owners to prevent smell by frequent cleaning).

Cats will often naturally bury their urine and faeces, and as a general rule, deeper litter (within limits) is better – that might make a large plant pot a better litter tray than anything else in the house! Research has shown that cats prefer 1-3cm deep litter for defecation. Similarly outside, a newly dug area of the garden or an expensive piece of fine gravel work might be the most attractive latrine site to a cat if the alternative is a garden with solidly packed earth or no earth available to dig. Cats prefer soft, easy to rake substrates; clay-based litter seems to be preferred.

A cat’s natural latrine is away from its hunting, feeding and main activity areas and it tends to use different areas for urinating and defecating. Owners should try to accommodate this, not only by following the ‘number of cats plus one’ rule regarding the number of litter trays, but also by making sure that trays are not placed next to food bowls or close to a busy thoroughfare. Somewhere secluded and quiet is ideal.

Reasons why cats may start to use alternative sites to the litter tray include:

  • Lack of early house
  • Removal of favoured latrine
  • Aggression from other
  • Tension in a multi-cat
  • Aversion to the litter tray location, substrate or tray
  • Unpleasant experience associated with the litter tray (eg, dirty litter tray, fearful event experienced while on the tray such as a loud noise, being interrupted (or given medication).
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What does this mean for veterinary clinics?

  • Litter tray problems can relate to If a cat has pain when urinating or defecating, it may well associate that pain with the place instead of the act. As cats get older, their joints become stiff or painful and they may be less mobile; e.g. a high-sided tray with deep litter that may have been favoured previously may become very difficult to climb into.
  • Poisons can be ingested via grooming the coat or feet rather than simply eating or
  • A poor coat can be a sign that the cat either cannot groom successfully or does not want to – this may be due to dental problems, osteoarthritis, cognitive dysfunction, hyperthyroidism, anxiety,
  • Grooming is also thought to have a calming or rewarding effect and may be used by a cat as a displacement
  • Cats prefer to feed and sleep away from a litter tray so the size of hospital cages and placement of the contents can affect feeding and
  • Cats may have a preference for a certain litter type, or a covered or open

Clients may misunderstand that:

  • For cats a comfortable place to use for urination or defecation means somewhere that they can easily dig and If it’s heavy, rough and unfamiliar or has the wrong consistency or smell for a cat, it just might not be used. A litter tray should be big enough to enable the cat to scratch around, turn and walk past its elimination with ease. This can help prevent problems from arising in the first place.
  • Litter deodorisers, fragrant litters and strong disinfectants are likely to be off-putting for cats.
  • The placing of a litter tray is also important for cats – they should be in quiet locations away from food and water, and where the cat will not be
  • The number of litter trays available to multi-cat households may not be

Self-reliant, emotional and highly aware

The cat does not need feline company – it can hunt for itself, find its own place to rest and defend its own territory. It can keep itself clean, its claws sharp and protect itself by being highly aware of its surroundings and using its agility, speed and strength to get itself out of trouble. Getting to safety is the option of choice in the face of danger. Where they do live together, cats do not form structured packs like dogs and there is no dominance hierarchy among a group of cats. The assumption that cats need the company of their own species is based on human perceptions of sociability. Cats can live in social groups, but only in specific circumstances such as feral colonies on farms – these are groups of related females where kittens grow up together from birth and where there is enough food and shelter for larger numbers. The cat is often not thought of as an emotional animal because we humans do not see it as having great facial dexterity and the ability to show a wide variety of subtle facial expressions. However, in order to survive, the cat experiences just the same range of emotions and feelings as other animals, including fear, pleasure and frustration as it learns about its environment, reacts rapidly to food opportunities and avoids danger. The cat maintains independence by living on its wits and relying on no one. Cats are excellent at hiding signs of illness or pain – they tend to stay still and quiet so as not to attract attention. Owners may not be aware that the cat is suffering. Cats are usually at their most content when they can dictate the timing of interaction with their owners and other humans. Allowing a cat to come to you is a good way to ensure you will be viewed in a positive light. Being able to climb to access to higher places to hide will make cats feel safer and more secure.

What does this mean for veterinary clinics?

  • Cats may react quickly if disturbed or As they can’t escape in a clinic environment they may resort to defensive aggression.
  • A slow quiet approach, avoiding eye contact (and using a slow blink), will minimise perceived
  • Avoid loud and high-pitched noises within the clinic as these can be very alarming to an already stressed
  • Scruffing or heavy handling can cause fear and
  • A single unpleasant event at the clinic can affect future visits for a
  • A frightened cat will often try to run away, so window and door security is
  • Cats are excellent at hiding signs of pain or Owners may have noticed behaviour changes but may not be aware of their relevance.
  • Increasing arousal signals can be
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Clients may misunderstand that:

  • Cats may choose not to be dependent and interactive with
  • Cats usually have no desire for a feline ‘friend’ – they are usually more content to live
  • Sharing territory with another cat can be
  • Cats may not wish to be confined or reassured by
  • Sights, sounds and smells in our everyday life can cause stress to
  • Like all mammals, cats are fast Obedience to humans is not proof of intelligence!
  • Emotions and behaviour can change very Cats may react quickly if disturbed or frightened.
  • Routine and predictability in a cat’s life can reduce stress and improve quality of
  • Changes in routine behaviour (such as sleeping more or avoiding contact) can occur because of emotional change or may indicate health
  • For cats, the need to keep themselves clean is very strong, so being deprived of the ability or opportunity to do so is potentially
  • Cats are excellent at hiding signs of illness or pain – they tend to stay still and quiet so as not to attract Owners may not be aware that their cat is suffering.

Influenced greatly by early experience

Although some cats will never accept living with another cat in the same household, most cats will enjoy human company if socialised to humans in early life. However, cats have to learn to enjoy interacting with people at a very young age if they are to accept people. Experiences that kittens have within their first two months of life are very important in influencing their behaviour and reactions as adults. The cat sleeping peacefully in the living room is no different, in many respects, from others which live completely independently outside, except in their exposure to man.

During the first few weeks of life the kitten learns its social identity and how to feed itself. Its mother will wean it from sucking milk onto eating dead and, later, live prey. This process gradually introduces the kitten to learn how to kill and hunt the prey it needs to survive. In a domestic setting the kitten also practises hunting behaviour. This is the origin of the batting, chasing and pouncing behaviour that all kittens spend a great deal of their time rehearsing. By participating in the play activities of kittens, using toys and games, we are taking part in their development in a very similar way to a mother and littermates.

Up to the age of about two months, the kitten is particularly sensitive to learning about its environment and establishing social bonds. Research conducted into the quality and quantity of handling during this ‘sensitive period’ shows there are distinct benefits to providing the necessary socialisation in the right way – kittens that are handled by at least four different people between the ages of two and seven weeks tend to be more sociable towards humans than those that didn’t benefit from such handling. The mix of humans should include male and female, young and old and handling should be for short frequent periods.

It’s not just about people; kittens also need to understand what it is like to live in a domestic home. Experiencing noise, children, dogs, vacuum cleaners, different locations and even car journeys enables the kitten to learn that not everything is to be feared.

As kittens approach adulthood they develop an adult set of personality characteristics that are partly determined by their genes, partly by their early experience and partly by environment and how they are treated. On average, sexual maturity occurs at around six to nine months of age, but can be earlier or

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later depending on what time of year the kitten is born. From this time until full social maturity, anything from 18 months to 4 years of age with an average of about 2 years, gradual changes take place in a cat’s personality and it starts to become territorial. In some cases kittens change from being sociable and bold, to become more solitary, self-reliant and cautious.

This period in the cat’s life represents the time when it truly discovers the value of its territory and its capacity to live as an individual. In male wild or feral cats this would also be when they gradually move away from the extended family group in which they were reared. This can be a worrying and upsetting time for cat owners because the young cat is straying further from home and entering into conflict with other cats — the value of neutering in reducing roaming can be seen at this time.

What does this mean for veterinary clinics?

  • Feral cats require a different, careful and organised approach, as they will not be easily
  • Cats are less able to cope with stress associated with people and the human environment if not socialised appropriately at an early age – fearful cats will need careful handling and hospitalised cats may need cages with more bedding to hide
  • The vital time for socialisation is before 8 weeks old – veterinary clinics can influence the breeders/cat owners/shelter workers who use the clinic to ensure that young kittens are exposed to the right experiences to produce confident pets.

Cats owners may misunderstand that:

  • Cats have unique personalities and not all cats are friendly or sociable with

There may be a limit to what can be done for nervous kittens or cats which have not had the right early exposure and feral kittens are unlikely to ever make good pets.

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