For me, the first commandment for veterinarians is: Do not let them hurt!
“I know this may come as a surprise to you, Mrs. Banker,” I told the distraught owner in the exam room, “but Whitworth has a form of arthritis called degenerative joint disease, which is affecting his lower back. This is likely why he is reluctant to jump like he used to.”
For years, the veterinary community did not acknowledge the fact that cats felt pain. Cats are such secretive animals that they simply do not wilt under the stress of pain, whether a sudden discomfort (such as from an injury) or a chronic pain (such as from arthritis). However, if we know our pets, and we watch them closely, often we are able to discern subtle signs of discomfort.
Signs Of Pain
Some of the symptoms that are most commonly seen in the older cat patient include the following, as well as other vague signs of discomfort.
- Decreased grooming
- Sitting in a hunched position
- Reduced jumping/ability to jump
- Difficulty getting in and out of the litter box
- Reluctance to go up and down stairs
As a veterinarian, my rule of thumb is the opening commandment as stated above: do not let them hurt. An animal is unable to tell me if they hurt, where they feel pain and how much they hurt with the same clarity that a human can. Therefore, if a cat is giving subtle signs to the owners that something isn’t right, or I diagnose a condition that I expect should cause some degree of discomfort, I proactively manage that pain.
In general, if a cat “tells” you in no uncertain terms that she hurts, she has been uncomfortable for a while, and that isn’t something I want on my watch.
Pain Medication For Cats
This situation always leads to the inevitable question that Mrs. Banker came back to me with: “Doc, what can we do? Is it safe to give a 16-year-old cat all of this medication for pain? What are the side effects?”
The answer to this question is one that should always be discussed in significant detail with your pet’s veterinarian. Cats are not small people, and they do not metabolize drugs like we do. Some over-the-counter pain medications for people are highly toxic to cats and can, in fact, kill them. If you believe your cat is in pain, get her to her veterinarian for a thorough examination.
Your veterinarian will want to establish a full database to assess the overall health of the cat. This generally will include a blood panel (one that checks liver, kidney, bone marrow and thyroid) as well as a urine sample (a more sensitive test of kidney function.) The liver and kidney are the prime eliminators of medications, and we always want to be sure they are up to par before starting a new drug.
Based on these tests, the veterinarian will be able to select the correct pain medication and the correct dose. Some medications are safe to give for a patient with kidney disease, while others are not. Some are safe to give, but need to have some dose alterations done. This is where very careful review of your cat’s overall health and disease processes is critical. The goal is to maximize comfort and minimize side effects.
Pain Management In Cats
In general, most veterinarians consider pain management to be a “multi-modal” process. In other words, we do not look for one “magic bullet” to fix the problem. Often, in the early stages, we will consider alternative options to improve the animal’s overall well-being. These include things like:
- Weight control, which can be dramatically helpful for the arthritic animal.
- Alternative therapies, including acupuncture and physical rehabilitation.
- Chiropractic care.
- Thermal modification (heat or cold support to an injured area).
- Environmental modifications help. Making that litter box lower to the ground and near where the cat sleeps certainly can make it more likely that it is used.
- Some supplements and nutritional changes may also improve the cat’s quality of life.
For many cases, these modifications may be enough. However, there are other instances where medications are needed to augment the supportive care. Many, many different classes of drugs are available for the therapy of pain; and some of these medications are given as a “sole agent” (in other words, the only medication) and others work best in combination. Finding the right medication for your pet is a delicate ballet with you, your cat and your veterinarian. Keeping a log of what seems to work for the animal and what side effects you are noticing will help the veterinarian to “tweak” the protocol to maximize efficacy.
Monitoring The Effects Of A Drug
So, what are you watching for, anyway? First off, how is your cat feeling? How is her appetite, her attitude, her ability to jump and get around? What has changed since we started the medication, either for the better or for the worse? Both positive (“She’s feeling better”) and negative (“She isn’t eating as well”) observations help us.
What are the top three things we want to know after starting your pet on a new medication?
1. How is your pet’s appetite? Is she eating better, worse or about the same as before? Many times, an animal who is feeling better will eat better. Similarly, some of the medications can affect the gastrointestinal tract, causing a reduction in appetite, or even vomiting or diarrhea — so knowing both what is going in and what is coming out is very helpful!
2. What is happening in the litter box? Early signs of grumpy kidneys may include more urine produced than normal. If those clumps are getting bigger or more frequent, we want to know about it! Sometimes, even weighing a “daily take” from the litter box can give you an objective measure of what is coming out. Likewise, if the stool is becoming firmer — or softer — these can also be side effects of the medications, and we want to know!
3. How is your pet feeling overall? Spending less time sleeping and more time grooming and socializing are big factors. I often encourage people to think back to how the cat did a year or so ago, and compare where she is now to where she was then. Is she able to jump to the counter to eat or onto the bed for a nap? How about up to the windowsill for some sun? We aren’t trying to restore your cat to kittenhood, but we do want to return life to an active, enjoyable quality for as many years as possible.
It is important to be proactive when controlling pain in your kitty. They can’t speak for themselves, and once pain has begun, it does have the tendency to “wind up” and become more difficult to manage. At the first sign you believe something is wrong, begin that careful dance with your veterinarian to help keep things in check as long as possible.
So what happened to Whitworth, Mrs. Banker’s cat? After discussing all of the options with his owner and checking some baseline lab work, we decided to start out with a combination of canned cat food to help reduce his weight (he was quite a big boy), a supplement to support his joints as much as possible, and a short course of non-steroidal anti-inflammatories designed for cats to try and reduce some inflammation and make him immediately more comfortable.
At his recheck visit in 30 days, Mrs. Banker was thrilled to say that he had lost a pound, and was significantly more active than he had been in several months. We kept several “back-up” medications in mind, so that over time, should his condition worsen, we can add in additional treatments to keep pace with his condition. With luck, we’ll be able to keep the old man up and jumping for many more years to come!