Care of your geriatric cat


My tabby cat, Trigger, is 12 years old and has gingivitis. I know this could be from an underlying cause, such as Feline Leukaemia Virus (FeLV) or Feline Immunodeficiency Virus (FIV) but, thankfully in his case, he isn’t positive for these. Trigger has been a fighter all his life; he’s very territorial. He has slowed down a lot but still enjoys his daily perimeter walk.

Thankfully, his appetite is still the same and he is “head honcho” of the cats. He takes no nonsense from the dogs and he never turns down a cuddle on a warm lap. What ailments can affect an older cat and what should I be looking out for?

Carol Werth – Cape Town

Dr Kathryn Knipe of Bryanston Veterinary Hospital answers…

With advances in modern veterinary health care, nutrition and improved care provided by owners, pets are living longer lives on average than in the past. There are, however, many health conditions that are more common in senior animals. That’s why it’s important that your ageing feline (and canine!) friends visit a vet at least once a year for an annual check-up.

As your cat becomes older, one may want to invest in annual blood tests to screen for early indicators of diseases that, if diagnosed early, can be more successfully managed and give your kitty a longer life expectancy.

It’s also important to know whether your cat is positive for FIV and FeLV, which are contagious to other cats but not humans. Both viruses can remain dormant in the body with no clinical signs of disease. Also, knowing if your cat carries one or both of these viruses is important in managing their health.

This article addresses some of the more common diseases or conditions encountered in senior cats. Many of these diseases share similarities in their presentation and how they develop, which is why your vet may want to run various tests after examining your cat in order to pinpoint the exact cause of its problem.

CONDITIONS OF THE MOUTH AND TEETH

Signs that your cat may be experiencing some problems in the mouth include pain or difficulty when trying to eat (some cats may even hiss at their food as chewing causes them pain), food aversion, salivating, halitosis (bad breath), weight loss due to poor appetite, having a poorly kept appearance due to decreased grooming and pawing at the mouth. There are various conditions that can lead to these signs.

Periodontal (meaning “around the teeth”) disease refers to the accumulation of dental plaque on your pet’s teeth, gingivitis (gum inflammation), recession of the gum line, loss of teeth and secondary bacterial infections of the mouth. This can be the result of poor dental hygiene.

Dental care for cats

Bacteria that occur naturally in the mouth will start to colonise and form a film over the surface of the teeth; this is why we brush our teeth every day. If this film is not regularly removed it will start to mineralise (forming a hard yellow to brown plaque over the teeth). At this point, the teeth will need to be cleaned by your vet under general anaesthesia. This plaque build-up leads to inflammation of the gums, which causes the gum line to recede. It also starts to penetrate the tooth socket, resulting in teeth becoming loose and then falling out.

For this reason, it may be beneficial to brush your pet’s teeth daily, although many cats won’t tolerate this. That’s why many of the modern dry kibble diets are designed with special crystals or fibres, or special kibble shapes and sizes to promote the cat chewing through it, leading to this film being scraped off the teeth.

If you suspect your pet may be suffering from periodontal disease, they should be examined by your vet, who will advise you on the necessary dental care required for your pet.

Lymphocytic-plasmacytic gingivostomatitis (LPGS)

Lymphocytic-plasmacytic gingivostomatitis (LPGS) refers to a condition in which the presence of dental plaque on the teeth triggers an auto-immune response (the immune system “malfunctions” and attacks the body’s own tissues) in the cat’s gums, leading to very painful inflammation in the mouth. Cats that are infected with FIV, FHV (Feline Herpes Virus) or FCV (Feline Calici Virus) may be more prone to developing this condition.

If your cat has LPGS, your vet will recommend a dental procedure to clean the teeth of the bacteria-containing plaque on the tooth surface, most likely followed by a course of antibiotics and regular oral hygiene at home. However, a large proportion of cats will not be cured by this intervention, and may require full-mouth or nearly full-mouth tooth extraction (i.e. removing the teeth).

Although this may seem extreme, it will likely give your cat a vastly improved quality of life, and these cats manage to eat even regular kibbles without much trouble. If your veterinarian advises this treatment, seriously consider it as it provides the most reliable long-term results. There are occasional cases that will still experience inflammation despite full-mouth tooth extractions; these will likely require chronic medical management.

Masses and tumours

Masses and tumours in the mouth and throat are not uncommon and may lead to very similar signs as periodontal disease or LPGS. During your cat’s annual health check, your vet will carefully examine the mouth to see if there are any such problems. They may even want to book your pet in for a general anaesthetic to examine certain parts of the mouth more closely, collect samples, and perform dental hygiene care.

Remember: the earlier any of these are found, the better the outcome, so make sure you book an annual veterinary appointment for your cat.

OSTEOARTHRITIS (ARTHRITIS)

Osteoarthritis refers to progressive, irreversible damage of the cartilage within the joints.

The primary cause of osteoarthritis, or degenerative joint disease, is damage to the joint cartilage. There are many potential causes, such as traumatic joint injuries, inflammatory joint diseases, joint infections and congenital abnormalities in the bones and joints, that lead to abnormal movement within joints. This damage to the cartilage results in a cycle of ongoing cartilage destruction.

Osteoarthritis is diagnosed on clinical examination and by taking X-rays of your pet’s joints. X-rays not only allow us to see the extent of the joint damage but also allow us to rule out other causes of pain, such as luxations (joints “popping out of joint”), fractures, or tumours in the bones.

Signs of osteoarthritis are related to pain.

Your pet may:

  • Be reluctant to walk around
  • Take long to rise from lying down
  • Be stiff and painful after exercise or prolonged rest
  • Be unusually irritable towards their owners and other pets

These signs are often far less obvious in cats than dogs, and one may interpret them as your pet “just getting old”. Cats may:

  • Be unwilling to jump up onto windowsills and furniture
  • Urinate or pass stools in unusual places due to being unable to climb into a litter tray with high edges
  • Growl or hiss when a particular area of the body is touched.

Treatment of osteoarthritis is multi-modal and includes:

Surgery: If the primary cause can be corrected by surgery, this is the first line of treatment. This includes conditions such as ruptured ligaments or patellar luxations (knee caps that slip off). However, if the underlying condition has been going on for too long, it may no longer be possible or helpful to perform surgery as the joint damage may have already progressed too far. In these cases, treatment is aimed at managing pain, improving your pet’s mobility and limiting ongoing joint damage.

In end-stage cases there are certain surgical procedures that can be performed to relieve pain, such as removing parts of the joint (for example removing the femur head – femoral arthroplasty) or fixing a joint in place so that it can no longer move (arthrodesis).

Weight loss: One of the cornerstones in the management of arthritis in overweight animals. Excess weight places undue strain on the joints and muscles. If your pets have a good, healthy muscle mass it also helps to support the joints.

Joint supplements: These provide natural anti-inflammatories such as Omega 3 fatty acids and chondroprotective agents (cartilage protecting) that help to slow down the progression of joint disease. There are various formulations available, as well as foods formulated with these ingredients already incorporated. Your veterinarian and veterinary support staff can assist you in choosing the best product for your pet.

Dealing with pain: As needed, your vet can also prescribe chronic painkillers/anti-inflammatories. If a chronic anti-inflammatory treatment is prescribed, it’s best not to stop using it when your pet starts “looking better”; it has been found in human studies that patients receiving chronic anti-inflammatory treatment started showing regeneration of joint cartilage with long-term use. It’s also important to keep your pet in a pain-free state.

If your pet is experiencing chronic, untreated pain, it will start to develop “wind-up pain”, a situation in which it experiences the pain more severely the longer it is left untreated. Pet owners often don’t realise how much pain their pets are in until they start administering pain medications. This is because the decline was so gradual that it was barely noticeable. Once they start receiving painkillers, their quality of life will often dramatically improve.

Physical therapy with a registered pet physiotherapist may also provide relief, and some pet owners have found value in alternative therapies such as acupuncture and homeopathy.

CHRONIC KIDNEY DISEASE

Chronic Kidney Disease (CKD) or Chronic Renal Failure (CRF) refers to the progressive loss of kidney function over the course time. (This must be differentiated from acute kidney failure as a result of various kidney injuries, which can still be corrected or may then progress to chronic kidney failure if too many nephrons of the kidney are damaged.)

The kidney is composed of millions of functional units called nephrons, which are cumulatively responsible for performing the kidneys’ functions of excreting waste products, maintaining electrolyte balance and preserving fluid balance in the body.

Causes of kidney damage include trauma to the kidneys (such as being hit by a car), kidney stones, kidney infections or exposure to certain toxins. Some breeds of cats also have heritable kidney abnormalities such as polycystic kidneys, which have fewer nephrons than a normal kidney and are thus prone to developing CKD earlier than other animals. Over time, these individual nephrons become damaged and die off, leading to a decreased ability of the kidney to perform its functions adequately. Once the kidneys have lost approximately 75% of their functional capacity, clinical signs of kidney disease will become evident. Most often CKD cannot be attributed to a single event leading to kidney damage but is rather the result of a lifetime of cumulative damage.

Cats with CKD may:

  • Lose weight
  • Eat less
  • Drink more water and urinate more
  • Have bad breath
  • Become anaemic
  • Have poor coat condition due to decreased grooming
  • Show behavioural changes.

These signs are the result of the build-up of toxins in your pet’s body that the kidneys usually remove, as well as abnormalities in electrolytes and fluid balance usually managed by the kidneys. Many of these signs are non-specific and occur with other conditions, which means that your vet will need to take blood and urine samples to test your cat and stage the progression of their disease.

Once diagnosed, your veterinarian may want to admit your pet to hospital to try to correct some of these fluid and electrolyte imbalances by the administration of intravenous fluids and other treatments to make your pet feel better. Following this, your vet will prescribe certain medications and diets to ameliorate the effects of decreased kidney function.

Quality of life care

It is important to remember that, if your cat has been diagnosed with CKD, it means that their kidneys have been damaged beyond repair; all steps at managing the disease are aimed at extending your pet’s life expectancy and giving them a good quality of life, as far as possible.

Some cats live for months with clinical CKD; others, sadly, do not respond to treatments and are humanely put to sleep soon after diagnosis. This disease can be detected by blood and urine tests before the onset of clinical signs, allowing early interventions early, which means a longer life expectancy for your pet.

This emphasises the importance of annual health checks, and blood and urine tests in geriatric cats.

HYPERTHYROIDISM

Hyperthyroidism is a disease caused by hyperactivity (overactivity) of the thyroid gland, whose hormones are largely responsible for maintaining a regular metabolic rate. The cause is usually benign overactive growth of cells in the thyroid gland for which a specific underlying cause has not been established. The disease is most commonly diagnosed in cats older than eight years of age and is more common in domestic shorthaired cats (“moggies”) than in purebred cats.

Clinical signs

Clinical signs are related to an increased metabolic rate and the effects of this on the body. Typical clinical signs include weight loss (often despite a good or increased appetite); increased water intake and urination; changes in behaviour such as hyperactivity, nervousness, aggression or sometimes unusually affectionate behaviour; vomiting and diarrhoea; weakness; lethargy; increased respiratory rate or panting; heat avoidance; and decreased grooming activity.

Again, many of these signs are non-specific and seen in numerous other diseases encountered in senior cats.

High blood pressure danger

Cats with hyperthyroidism often have very high blood pressure, which leads to various other conditions. It can result in irreversible thickening of the heart wall muscles, which can lead to congestive heart failure.

It also places a lot of strain on the kidneys, which can damage them in the long run. Unfortunately, the high blood pressure often masks the signs of kidney disease despite that the kidneys are not functioning adequately. This can be attributed to increased blood pressure forcing the kidneys to work faster and harder, thus maintaining the levels of toxins in the body within normal limits. Once treatment for hyperthyroidism is initiated in these patients, they may start to show signs of CKD (i.e. it is unmasked).

At this point, your vet will work closely with you and your pet to determine which of the two conditions, CKD or hyperthyroidism, is causing your pet the most discomfort and try to manage that.

High blood pressure may also lead to retinal detachment or tears, which may make your cat blind.

There are various treatments and interventions available for these patients, ranging from surgery to removal of the overactive thyroid gland, oral medications, radioactive iodine therapy (unfortunately not yet available in South Africa) to specific prescription diets. Your veterinarian will guide you in finding the best treatment option for you and your pet.

The average life expectancy for cats diagnosed with clinical hyperthyroidism (i.e. showing signs of the disease) is approximately two years.

WHEN ALL’S SAID AND DONE

Hard as it is to accept, if your pet is diagnosed with any untreatable disease and is not happy anymore (i.e. not enjoying a good quality of life), euthanasia should be considered as the final kindness we can offer our pets. Your vet will advise you when they feel that it is the best option.

In our older pets, there are many diseases that they are prone to developing; many of these diseases appear very similar until various tests have been performed to establish a diagnosis. Importantly, many of these diseases have a better prognosis if diagnosed early.

Therefore, carefully monitor your senior pets for any subtle changes in behaviour, weight, appetite, grooming behaviour, water intake and frequency of urination. All of these give your vet important information to diagnose a potential problem early.

Annual health checks, including – in geriatric patients (dogs and cats) – various laboratory tests, will improve the chances of your pet living its senior years in comfort with you.