Caring for the Senior Cat

Chronic Renal Insufficiency

Chronic kidney disease (also known as renal insufficiency) is one of the most common diseases seen in older cats.

Just like people, cats have 2 kidneys. The kidneys are responsible for filtering the blood and removing some of the toxins, as well as assisting in maintaining hydration and producing urine. As cats become older, their kidney function gradually declines. More than 90% of cats over the age of 10 will have some level of kidney dysfunction; however we only start to see clinical signs of renal disease when more than 70% of kidney function has been lost. This means we often do not see obvious signs of the disease until the kidneys are severely damaged and the cat is quite unwell. If corrected, cats can often survive and thrive quite happily for years with well managed chronic renal insufficiency.

What to look for at home:
- A sudden increase in thirst
- Urinating larger volumes or more frequently
- Weight loss often with loss of muscle tone.
- Poor hair quality - Halitosis (bad breath) occasionally with oral ulcers.
- Variable appetite
- Vomiting or diarrhoea
- Lethargy and depression.

If you are concerned about any of these signs, please contact the clinic immediately and bring your cat in for a check up.

What can your vet do to test for Chronic Renal Insufficiency?

Renal disease can be difficult to diagnose in the early stages, but with regular testing we can monitor for changes that may indicate underlying disease requiring treatment including:
- Regular wellness checkups with your vet and weight checks.
- Regular blood tests (at least annually, ideally every 6 months) to assess for elevations in certain blood products that indicate kidney function (Urea, Creatinine and phosphate),
- Regular urinalysis every 6 months checking for normal concentrating ability, protein levels, signs of infection and the urine protein:creatinine ratio
- Regular blood pressure monitoring every 6 months

What can you do to prevent renal disease in your cats?

1. Early detection through regular checkups and tests and commencing early treatment if we are concerned about renal disease.
2. Monitoring for any signs of renal disease at home and bringing them in for checks immediately.
3. Ensuring adequate water supply. Older cats often have arthritis and are unwilling to move as much as they were in their youth, so having multiple bowls of clean fresh water around the house in easy reach of your cat’s favourite locations is a great idea. Cats also love flowing water and often prefer to drink from fountains rather than bowls. Wet food can also increase the amount of water in your cat’s diet.
4. Start on a kidney specific diet that is low in phosphate and protein. Diet plays a huge role in slowing the progression of chronic kidney disease. A premium, kidney specific diet such as Royal Canin Renal or Hill’s k/d can help manage chronic renal disease quite effectively until the later stages of the disease by reducing the amount of waste by-products they have to remove and thus preventing the kidneys from having to work as hard.

In summary – through monitoring at home, regular testing, appropriate diet and promoting water consumption can all help to prevent the progression and clinical signs of chronic kidney disease in your cat.

Hyperthyroidism

Hyperthyroidism is a disease of the Thyroid gland, where it is over-producing thyroid hormone. This hormone is used by the body to control metabolic rate. This causes the body to start to work in overdrive and can cause serious changes with most organs in the body, in particular heart enlargement, hypertension and kidney damage. This over production often occurs most often due to an overactive gland, but in 2% of cases it can be associated with a malignant tumour. With treatment, especially early treatment this condition can be controlled and in some cases cured (with radioactive iodine therapy).

What to look for at home:
- Increased thirst and urination
- Ravenous appetite, often with weight loss
- Occasional or increased vomiting or diarrhoea
- Unkempt coat.
- Signs of high blood pressure – often manifesting as sudden onset blindness.
- Behaviour changes – particularly an increase in aggressive tendencies.

If you are concerned about any of these changes please contact the clinic and organize a health check.

What can your vet do to check for Thyroid disease?

We can check Thyroid hormone levels by performing blood tests. Routine blood tests at least annually as well as 6 monthly blood pressure checks, regular preventative care exams performed by your vet and monitoring for changes at home can assist us in diagnosing hyperthyroidism earlier.

Unfortunately there is little we can do to prevent Hyperthyroidism, but early detection (through monitoring and blood tests) and treatment before the disease becomes advanced or causes changes in other body systems can make a huge difference to the quality and length of your cat’s life.

Arthritis

Arthritis is a complex disease involving the painful inflammation and degeneration of joints. There are many and varied causes of arthritis ranging from congenital abnormalities through to old age degeneration. Cats are notorious for hiding signs of pain and arthritis often goes unnoticed as a result.

What to look for at home?
- Less inclined to jump up as high as they used to. E.g. using a chair to get on a table, rather than jumping directly to the table.
- Hesitant to jump off tables
- Spend less time playing and more time sleeping
- Hesitant to climb stairs
- Reduced grooming
- Signs of pain or “being grumpy” when picked up or handled along their back.
- Limping in severe cases.

If you are concerned about any of these changes please contact the clinic.

What can your vet do to diagnose arthritis?

Regular preventative health checks to monitor for any signs of pain and starting treatment to stop the pain of arthritis and reduce the progression of this debilitating disease. We can confirm the presence of arthritis by performing radiographs.

Arthritis is a manageable disease with pain relief, zydax injections (joint modifying drug that reduces inflammation and slows cartilage breakdown) and starting on joint specific diets or nutriceutical additives such as green lipped mussel extract, glucosamine and condroitin which help improve cartilage function.

What can you do at home to prevent arthritis?

1. Maintain a healthy weight. Obesity adds extra pressure to joints, exacerbating pain and speeding the progression of arthritis. It also increases the risk of developing diabetes, urinary tract disease and heart problems. To check if your cat is a healthy weight, just ask your vet at your next preventative health check. If they are overweight, starting a strict weight loss diet such as Royal Canin obesity, Eukanuba weight control or Hill’s r/d and feeding for the weight that they should be is a great start to their weight loss program. Splitting the food into a morning and evening meal, and preventing grazing by removing food if it hasn’t been eaten within 15 minutes can also help reduce weight.

2. Start on a senior/joint specific diet or add supplements such as glucosamine, condroitin and green lipped mussel extract to the diet.

3. Encourage regular exercise. Whether it be taking them for a walk or encouraging low grade play activities

4. Monitor for changes in behaviour that could indicate discomfort and contact your vet for a full examination and further work up if required.

5. Make your house arthritis-friendly. Ramps to and from their favourite spots, easy access litter trays with lower edges, multiple feeding/water stations and litter trays within easy reach of common resting sites and a soft, comfortable, warm area for resting/sleeping.

Dental disease:

Dental disease involves a range of oral problems from mild plaque (mild bacterial byproducts build up) to tartar and calculus (mineralized bacterial products that form a thick hard layer, allowing the proliferation of bacteria) to gingivitis (reversible inflammation of the gums) to severe periodontal disease (irreversible, extremely painful damage to the ligaments and bone that hold teeth in place). We commonly see resorptive lesions (holes in the enamel of the tooth) in cats. This is exceptionally painful and often requires the removal of the tooth. Early intervention to prevent the progression of dental disease can reduce the need for teeth extraction later in life and significantly reduce pain. More than 60% of cats over 3 years of age have some level of dental disease.

What to look for at home?
Common signs of dental disease can include:
- Foul smelling breath
- Obvious discomfort when chewing,
- Dropping food out of their mouth
- Reduced food intake or enthusiastically approaching food bowl, but then not actually willing to eat much.
- Dribbling excessively, occasionally with blood present
- Preference for wet food or reluctance to eat dry. Can occasionally appear as a “picky’ eater.
- Shaking head or pawing at mouth
- Reduced grooming

If you are concerned about any of these changes please contact the clinic and organize a health check.

What can your vet do to diagnose dental disease?
Regular oral exams to monitor dental disease progression are important. Many cats require a regular (annual) dental scale and polish under anaesthetic to remove tartar/calculus and keep their gums healthy. Some cats will require multiple tooth extractions, and once periodontal disease is present they are likely to have ongoing issues if the teeth are not removed.

What can you do at home?
1. Check your cat’s mouth regularly for any signs of tartar build up or foul smelling breath. Ask your vet to show you how. If you notice any signs of dental disease, prompt action can prevent progression to periodontal disease.
2. Dental diets, such as Royal Canin dental or Hill’s t/d, can help clean away tartar and reduce future build ups of plaque. Other options include feeding a chicken wing or a thick (ideally 2cm x 2cm x 10cm) strip of raw meat such as chicken, beef or kangaroo, once daily to promote chewing and prevent plaque build up.
3. A water additive such as Aquadent can significantly reduce plaque build up.

In summary regular dental check, dental care and dental maintenance can prevent further progression of this painful disease.

Diabetes Mellitus

Diabetes mellitus is a serious medical condition causing a persistently high blood glucose level.

Blood glucose levels are modulated my several factor such as stress, diet, exercise and the hormones insulin and glucagons. Insulin allows the glucose to be taken up into the cells of the body. In cats, diabetes is commonly due to a reduction in the production of insulin and/or a reduced sensitivity of the cells of the body to the insulin. In severe untreated cases, diabetes is a medical emergency. Increased risk factors for cats include obesity, breed predispositions especially oriental type breeds, stress (such as changes in environment, new cats entering the household or illness of another cause) and long term use of some medication such as corticosteroids. However long term dietary and insulin management can allow excellent glycaemic control and a long, good quality life.

What to look for at home?
- Increased drinking
- Increased urination
- Increased weight loss with an increased appetite
- Urinating abnormally i.e. in different places, on the floor rather than the litter tray
- In severe cases, lethargy, collapse and even death.
If you notice any of these signs please contact your vet and organize a health check.

What can your vet do to diagnose diabetes?
Diabetes in cats is a complicated issue as severe stress, such as a visit to the vets, can cause an elevation in glucose levels. A thorough clinical examination, general blood test including glucose levels and a urinalysis are the starting points to diagnosing diabetes. In cats we commonly also perform a fructosamine assay which helps assess the body’s glucose levels over several weeks, rather than just what their levels are at that point in time. If diabetes is diagnosed, then treatment with insulin injections, a special diabetic specific diet and regular blood glucose testing will be required.

What can you do at home?
1. Weight loss can help prevent diabetes. Keeping your cat within normal weight limits is important for their overall health and life expectancy.

2. Feed discrete meals rather than allowing grazing. Grazing encourages persistently high blood glucose levels and predisposes to diabetes, obesity and urinary tract problems.

3. Reduce stress in the environment. Prevent stray cats entering the yard, provide safe, quiet, elevated areas for your cat to rest/hide, especially when there are strange people in the house or strange noises outside (such as road works), and Feliway – a feline facial pheromone analogue, can assist in calming anxious cats.

4. Monitor for signs of diabetes and contact your vet immediately if concerned.

Neoplasia

Neoplasia is another word for cancer. While tumours can be found at any age, older cats have an increased risk of developing malignant (aggressive) tumours. Veterinary therapy is constantly advancing and some cancers can be treated effectively with surgery or chemotherapy. If you are concerned about any lumps, bumps, sores or scabs, abnormalities with eating, drinking, urinating or defecating, then please contact the clinic. Two of the most common tumours in cats are nasal squamous cell carcinomas and lymphoma/lymphosarcoma.

Nasal Squamous Cell Carcinoma
This is a locally infiltrative tumour of the nose, most common on cats with a pink or pale skinned nose. It causes the painful ulceration of the nose and is often seen initially as a pink change, progressing to an ulcerated surface and eventually a scab. In severe untreated cases is can begin to eat away the nose. If treated early with cryotherapy (freezing) or cautery (burning), the progression of this disease can be significantly slowed or halted.

Lymphoma/Lymphosarcoma.
Lymphoma or lymphosarcoma is a disease of the lymphatic system and the cells that help form the immune system of the body (lymphocytes). These cells are found throughout the body. As a consequence lymphoma can occur in almost any body organ. The most common forms include – skin, lymph node, gastrointestinal system associated, central nervous system and systemic disease. This means that there are a variety of different signs that cats may exhibit if they have lymphoma. These include, chronic vomiting or diarrhoea, coughing or difficulty breathing, lumps on their body, especially enlarged lymph nodes, lethargy and inappetance, changes in drinking and urination, and other signs specific to the affected site. Viral disease such as Feline leukaemia virus (FeLV) and Feline immunodeficiency virus (FIV) have been associated with lymphoma in cats. These diseases can be prevented with vaccination, but do require testing before a vaccination course can be started.

In many cases Lymphoma can be managed with chemotherapy to prolong and maintain a good quality of life, especially if noticed early in the disease course.

Age – Related Cognitive Dysfunction

As with older people, as the brain and the body begins to age, we may notice some mental changes (commonly referred to as senility). In cats these changes are often associated with degeneration of other body organs for example – cats with reduced vision may become more clingy or call out when people leave the room, or they may begin to urinate in abnormal spots because they are too arthritic to get to the litter tray in time. Some issues can be resolved with changes to the environment or medication if required.

For more information please speak to your vet.

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