Feline Physiotherapy and Rehabilitation: 2. Clinical application

Practical relevance: There is an increasing demand for effective postoperative and post-injury rehabilitation for any cat with compromised physical function due to injury, surgery or disease. Clinical challenges: The design of a suitable rehabilitation programme that will assist the recovery process, as well as ensure the return of neuromusculoskeletal control to the highest levels of function possible, requires a good understanding of feline behaviour, accurate assessment of the cat's condition and the correct implementation of a range of physiotherapeutic modalities. Audience: This two-part review article is directed at the primary care veterinary team. The clinical application of a variety of physiotherapeutic modalities in the rehabilitation of cats is examined in this second part. Evidence base: Although evidence supporting the benefits of physiotherapy and rehabilitation with cats is sparse, many techniques, treatments and rehabilitation regimens successfully used on human patients are being readily adapted for animal use. Treatment recommendations described in this review are primarily based on the author's experience, and that of colleagues, except where specific reference is made to published evidence.     

AAFP and ISFM feline-friendly handling guidelines

BACKGROUND: The number of pet cats is increasing in most countries, often outnumbering pet dogs, yet cats receive less veterinary care than their canine counterparts.(1) Clients state the difficulty of getting the cat into a carrier at home, driving to the clinic, and dealing with the fearful cat at the veterinary clinic as reasons for fewer visits.(2) Educating and preparing the client and the veterinary team with regard to respectful feline handling is necessary in order to avoid stress and accomplish the goal of good health care. Without such preparation, feline stress may escalate into fear or fear-associated aggression. The resulting stress may alter results of the physical examination and laboratory tests, leading to incorrect diagnoses (eg, diabetes mellitus) and unnecessary treatments.(3-5) Without compassionate and respectful handling by the veterinary team, clients may feel the team lacks skills and compassion, or does not understand cats. Injury may occur to the cat, client and/or veterinary team.(6) Clients who want to avoid stress for their cat may avoid veterinary visits or choose another practice instead. GOALS: The use of feline-friendly handling techniques should reduce these problems. Handling is most successful when the veterinary team adapts the approach to each individual cat and situation. The goal of these guidelines is to provide useful information for handling cats that can lead to: ? Reduced fear and pain for the cat. ? Reinforced veterinarian-client-cat bond, trust and confidence, and thus better lifelong medical care for the cat. ? Improved efficiency, productivity and job satisfaction for the veterinary team. ? Increased client compliance. ? Timely reporting and early detection of medical and behavioral concerns. ? Fewer injuries to clients and the veterinary team. ? Reduced anxiety for the client.     

Understanding feline behavior and application for appropriate handling and management

Feline handling in the veterinary hospital is important to protect both people and cats. Restraint has been used to enable us to perform our duties as veterinarians. With increased knowledge of feline behavior and how cats react to fear, newer information provides us with safer handling techniques. With safer and more respectful handling based on understanding the nature of cats and their communication, we can improve feline health care in our hospitals, the human-animal-veterinarian bond, and the welfare of both cats and people. This article explains important aspects of feline communication and how our actions affect cats. By understanding the cat, we can improve our handling techniques to prevent fear and pain for our feline patients, and thus make our veterinary practices more feline friendly and safer for our clients, their cats, and veterinary staff.     

Prognostic studies of canine and feline mammary tumours: the need for standardized procedures

For several years, veterinary oncologists have been struggling with the prognosis of mammary tumours in dogs and cats. Translation of tumour characteristics into prognostic information is an invaluable tool for the use of the most appropriate therapies, as well as for planning innovative therapeutic trials. Moreover, canine and feline spontaneous mammary gland tumours are good models for the study of human breast cancer. Collecting and interpreting information regarding the prognosis of canine and feline mammary tumours is difficult due to the fact that different methods have been applied to study various components and characteristics. This review identifies some of the challenges of prognostic studies of spontaneous canine and feline mammary tumours and suggests standardized procedures to overcome these challenges and facilitate reproducibility and assessment of results.     

Comparison of interpretation of cat's behavioral needs between veterinarians,veterinary nurses,and cat owners

Cats have certain strongly motivated behaviors, which could be defined as “needs,” that should be understood to provide the cat the best quality of life and assure proper welfare. It is well recognized that cats have several behavioral needs, which if not met, can result in anxiety and secondary behavior problems. These problems can lead to relinquishment or euthanasia. Veterinarians and veterinary nurses have a special role when educating owners. To increase owners' compliance, veterinary professionals should have evidence-based knowledge for the right information to be communicated to feline owners. The goal of the present study was to identify and compare the level of knowledge that veterinarians, veterinary nurses, and pet owners have about cat behavior and to compare their perceptions on this subject. We were also interested in determining whether living with a cat affected the professionals' knowledge base and what they are able to properly communicate to pet owners. It was expected that the veterinarians would have the highest level of knowledge regarding the interpretation of feline behavioral needs. We also hypothesized that those professionals who had or have previously owned a cat would have a better understanding of what cats actually need. A questionnaire, called “questionnaire to assess cat's needs” (QACN), was completed by cat owners, veterinarians, and veterinary nurses. The QACN had 13 different statements about the behavioral needs of cats, and each participant had to select their level of agreement with the statement. The QACN was then scored and a principal component analysis was used to identify meaningful associations. The following 3 components were extracted: elimination, stress releasers, and human stimulation. Contrary to what was expected, the results showed that in some specific areas (stress releasers and human stimulation) veterinarians' and veterinary nurses' knowledge was not significantly different from that of cat owners. This could mean that the role of these professionals in preventing behavioral problems can be very compromised. Those professionals who had owned a cat personally were better at identifying the behavioral needs of cats, with some significant differences (related with stress releasers), compared with those professionals who had never owned a cat. More education about feline behavior should be included when training veterinarians and veterinary nurses for clients to continue to trust these professionals to provide them with evidence-based knowledge about cat behavior.     

Feline leishmaniosis due to Leishmania infantum in Italy

A case of leishmaniosis in domestic cats (Felis catus domesticus) is described. The subject showed a nodular lesion on the eyelid. The diagnosis was achieved by serological, parasitological, and light and electron microscopic investigations. By molecular techniques the aetiological agent was identified as belonging to Leishmania infantum, the species implicated in human and canine leishmaniosis in southern Europe. A preliminary study on the prevalence of asymptomatic feline leishmaniosis, performed in the areas where the infected cat was identified, revealed a low seroprevalence of infection: only 1 (0.9%) of the 110 cat sera examined by indirect fluorescent antibody test was positive for anti-Leishmania antibodies. Because clinical signs in feline leishmaniosis are unspecific and similar to those observed in other diseases commonly found in this species, leishmaniosis must be added to the differential diagnosis by feline veterinary practitioners and adequate serologic and histopathologic investigations must be performed in endemic areas.     

Fractious cats and feline aggression

Despite variation in terminology it is clear that the context in which feline aggression occurs is important for classification, prevention and treatment. Many of the aggressions discussed can be considered variants of normal feline behavior, so client education is particularly important. Educated clients will know when their cat can benefit from veterinary intervention, and when closing a door may be sufficient. The goals of treating all feline aggressions should be safety for all concerned, and quality of their living environment for the cats. The greater our knowledge, the more likely we are to achieve these goals.     

Principles of treatment for feline lymphoma

Lymphoma is the most commonly diagnosed neoplasm in cats. As feline leukemia virus antigenemia has decreased over the past 15 years, there has been a profound shift in the presence, signalment, and frequency of sites of feline lymphoma in North America. There is variation in anatomic classification systems, but most studies have divided lymphoma into four groups: alimentary, mediastinal, multicentric, or extranodal. Clinical signs and common differential diagnoses for each of the forms are described. Staging allows for evaluation of the extent of disease. As in the dog, lymphoma is a systemic disease in the cat, and chemotherapy is the treatment of choice for most forms. Exceptions are described. In contrast to canine lymphoma, feline lymphoma is generally more challenging and frustrating to treat than canine lymphoma. Response rates are lower, and remission duration is shorter. Fortunately, cats treated with chemotherapy tend to have less toxicity than dogs. Positive prognostic factors are feline leukemia virus-negative, clinically well at time of diagnosis, and response to therapy. Achieving a complete remission is prognostic for survival. Unfortunately, response cannot be predicted before treatment.     

Clinical pain management techniques for cats

Although pain management is an emerging and popular topic in veterinary medicine, use of analgesics in cats has received little attention relative to their canine counterparts. Some of the difficulty lies in assessment of whether or not a cat is in pain. Simple observation of a cat in a cage relies upon overt expression of pain, and is often inaccurate. Pain scales have been developed that allow a semiquantitative evaluation of the degree of pain an animal may be experiencing. However, treating pain based upon observation of the painful state is less effective than anticipating and preemptively treating pain. This article reviews specific methods for preemptively treating and alleviating pain in the cat. The traditional approach to pain management involves drug administration. Specific categories of agents used in cats include opioids, nonsteroidal anti-inflammatories, or alpha-2 agonists. Other modalities of pain management, which are also reviewed, include use of local anesthetic drugs for local and regional analgesia, as well as acupuncture.     

Conjunctival lymphoma: immunophenotype and outcome in five dogs and three cats

Conjunctival lymphoma is well documented in the medical literature, but veterinary reports are few. We report five cases of canine lymphoma, and three of feline in which the presenting sign was conjunctival involvement. All animals were in apparently good health at the time of presentation, and attended the referring clinic because of conjunctival disease. One dog showed generalized lymphadenopathy at presentation, although the ocular lesion was the reason for consultation, but all other patients were well with no detectable disease beyond the eye. All cats were presented for their ocular disease. All dogs were confirmed to have T‐cell tumors, although the histological appearance of these was variable. In contrast, all cats had B‐cell tumors. Referring clinicians and owners were contacted for follow‐up information. Three dogs had been euthanased within 6 months of diagnosis for deterioration of general health. The remaining two were alive and showed no signs of systemic disease. Two cats had good survival following diagnosis, the other died of lesions that may not be related.     

Magnetic resonance imaging of the canine and feline eye, orbit, and optic nerves and its clinical application

The purpose of this study was to investigate magnetic resonance imaging of the normal canine and feline eye, orbit and optic nerves using proton density-weighted, T₁-weighted and T₂-weighted images. The clinical application of magnetic resonance imaging in veterinary ophthalmology was also investigated using three clinical cases: a feline orbital melanoma, a feline optic nerve meningioma, and a canine orbital fibrosarcoma. Gadolinium diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging was completed on the case of feline optic nerve meningioma. Magnetic resonance imaging provides excellent anatomical detail of the canine and feline eye, orbit, and optic nerves due to its superior soft tissue contrast, and its multiplanar and multislice imaging capability. Therefore it is of value for diagnostic imaging of some ophthalmic and neuro-ophthalmic conditions in the dog and cat.     

Thrombolytic Therapy in Dogs and Cats

Objective: To review the thrombolytic agents most commonly used in humans, their mechanisms of action, potential uses, adverse effects, and reports of their use in dogs and cats.
Human data synthesis: Thrombolytic agents avaliable in human medicine include streptokinase, urokinase, tissueplasminogen activator (t-PA), single-chain urokinase plasma activator (scu-PA) and anisoylated plasminogen-strep-tokinase activator complex (APSAC). These agents were originally used for the management of proximal deep vein thrombosis and severe pulmonary embolism but more recently, use of these drugs has been extended to include the treatment of acute peripheral arterial disease, cerebrovascular disease (stroke) and acute coronary thrombosis. The most predictable side effect associated with the use of thrombolytic therapy is hemorrhage.
Veterinary data synthesis: Clinical experience with thrombolytic agents in small animals is limited to streptokinase and t-PA. It is possible, that as in humans, canine and feline patients with PTE and right ventricular dysfunction may benefit from thrombolytic therapy but there are no veterinary studies to support this theory to date. Successful use of streptokinase has been documented in a small number of canine patients with systemic thromboembolism. ⁶³ Thrombolytic therapy is relatively efficacious in cats with aortic thromboemboli but is associated with a high mortality rate. ^59,60,64 With regard to use of t-PA in veterinary medicine, the small number of animals treated with varying protocols makes it impossible to provide safe and effective dose recommendations at this time.
Conclusions: Future goals for thrombolytic therapy in veterinary medicine include determination of more specific clinical indications, as well as design of effective protocols that minimize mortality and morbidity.     

Epidemiology of feline infectious peritonitis among cats examined at veterinary medical teaching hospitals

OBJECTIVE: To determine proportions of cats in which feline infectious peritonitis (FIP) was diagnosed on an annual, monthly, and regional basis and identify unique characteristics of cats with FIP. DESIGN: Case-control study. SAMPLE POPULATION: Records of all feline accessions to veterinary medical teaching hospitals (VMTH) recorded in the Veterinary Medical Data Base between January 1986 and December 1995 and of all feline accessions for necropsy or histologic examination at 4 veterinary diagnostic laboratories. PROCEDURE: Proportions of total and new feline accessions for which a diagnosis of FIP was recorded were calculated. To identify characteristics of cats with FIP, cats with FIP were compared with the next cat examined at the same institution (control cats). RESULTS: Approximately 1 of every 200 new feline and 1 of every 300 total feline accessions at VMTH in North America and approximately 1 of every 100 accessions at the diagnostic laboratories represented cats with FIP. Cats with FIP were significantly more likely to be young, purebred, and sexually intact males and significantly less likely to be spayed females and discharged alive than were control cats. The proportion of new accessions for which a diagnosis of FIP was recorded did not vary significantly among years, months, or regions of the country. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that FIP continues to be a clinically important disease in North America and that sexually intact male cats may be at increased risk, and spayed females at reduced risk, for FIP. The high prevalence of FIP and lack of effective treatment emphasizes the importance of preventive programs, especially in catteries.     

Immunomodulation and immunodeficiency

This article briefly reviews the concepts of immunodeficiency and immunomodulation as they relate to selected skin diseases in the dog and cat. Immunodeficiency states are uncommon and may be associated with a subnormal or down-regulated immune system, including humoral deficiencies, such as IgA, and abnormal lymphocyte or neutrophil function. Establishing a causal relationship between a skin disease and presumed immunodeficient state has been difficult due to the rarity of such conditions, and the limited nature of the techniques used to characterise the immune system response. Severe combined immunodeficiency in dogs is a well characterised primary immunodeficiency state involving lymphocytes; retrovirus infection in cats may lead to an acquired immunodeficient state with some association with certain dermatological conditions although it remains unclear that infection is causally linked with disease. Immunomodulation usually implies stimulating the immune system along a beneficial pathway. Such a therapeutic approach may involve a wide variety of agents, for example intravenous immunoglobulin. There are few randomised controlled trials with veterinary patients that unequivocally demonstrate beneficial responses to immunomodulatory agents. Interferons are cytokines of major interest in human and veterinary medicine for their antiviral, anti-tumour and immunomodulatory effects. The advent of veterinary-licensed products containing recombinant interferon may enable demonstration of the efficacy of interferons for conditions such as canine papillomatosis and feline eosinophilic granuloma complex. Canine pyoderma has been treated with a number of presumed immunomodulatory agents with limited success. With more detailed knowledge of the pathogenesis of pyoderma it may be possible to develop efficacious immunomodulators.     

Recombinant human thyrotropin in veterinary medicine: current use and future perspectives

Recombinant human thyrotropin (rhTSH) was developed after bovine thyrotropin (bTSH) was no longer commercially available. It was approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) as an aid to diagnostic follow-up of differentiated thyroid carcinoma in humans and for thyroid remnant ablation with radioiodine. In addition, rhTSH is used in human medicine to evaluate thyroid reserve capacity and to enhance radioiodine uptake in patients with metastatic thyroid cancer and multinodular goiter. Likewise, rhTSH has been used in veterinary medicine over the last decade. The most important veterinary use of rhTSH is thyroidal functional reserve testing for the diagnosis of canine hypothyroidism. Recent pilot studies performed at Ghent University in Belgium have investigated the use of rhTSH to optimize radioiodine treatment of canine thyroid carcinoma and feline hyperthyroidism. Radioiodine treatment optimization may allow a decreased therapeutic dosage of radioiodine and thus may improve radioprotection. This review outlines the current uses of rhTSH in human and veterinary medicine, emphasizing research performed in dogs and cats, as well as potential future applications.     

Genetic complexity and multiple infections with more Parvovirus species in naturally infected cats

ABSTRACT: Parvoviruses of carnivores include three closely related autonomous parvoviruses: canine parvovirus (CPV), feline panleukopenia virus (FPV) and mink enteritis virus (MEV). These viruses cause a variety of serious diseases, especially in young patients, since they have a remarkable predilection for replication in rapidly dividing cells. FPV is not the only parvovirus species which infects cats; in addition to MEV, the new variants of canine parvovirus, CPV-2a, 2b and 2c have also penetrated the feline host-range, and they are able to infect and replicate in cats, causing diseases indistinguishable from feline panleukopenia. Furthermore, as cats are susceptible to both CPV-2 and FPV viruses, superinfection and co-infection with multiple parvovirus strains may occur, potentially facilitating recombination and high genetic heterogeneity. In the light of the importance of cats as a potential source of genetic diversity for parvoviruses and, since feline panleukopenia virus has re-emerged as a major cause of mortality in felines, the present study has explored the molecular characteristics of parvovirus strains circulating in cat populations. The most significant findings reported in this study were (a) the detection of mixed infection FPV/CPV with the presence of one parvovirus variant which is a true intermediate between FPV/CPV and (b) the quasispecies cloud size of one CPV sample variant 2c. In conclusion, this study provides new important results about the evolutionary dynamics of CPV infections in cats, showing that CPV has presumably started a new process of readaptation in feline hosts.     

Diagnosis of congenital and adult-onset hypothyroidism in cats

Whereas hyperthyroidism is the most common endocrine disorder in the cat, hypothyroidism is the least common feline endocrine disorder. This is a the result of several factors including low index of suspicion, rarity of the naturally occurring hypothyroidism in cats, and a lack of species specific tests for endogenous TSH and antithyroglobulin antibodies. Nonetheless, hypothyroidism does occur in cats, especially in kittens and after radioactive treatment for hyperthyroidism. The clinician should become familiar with the common presentations of congenital and adult-onset hypothyroidism in cats. In addition, some of the tests specific to dogs (such as endogenous canine TSH) may be utilized to diagnose subclinical hypothyroidism in cats. Fortunately, the treatment of feline hypothyroidism with synthetic levothyroxine is both straightforward and effective.     

From problem to success: feline weight loss programs that work

PRACTICAL RELEVANCE: Obesity is the most common unhealthy nutritional condition that is recognized in cats. Documented associated health risks include diabetes mellitus, lameness, non-allergic skin disease, feline lower urinary tract disease and idiopathic hepatic lipidosis. CLINICAL CHALLENGES: Simply recommending a diet designed for weight loss fails, in most cases, to result in successful weight loss in the obese or overweight cat. A more in-depth approach that centers on communication and commitment, alongside a program of feeding a predetermined amount of a specific diet plus exercise and enrichment of the cat's life, offers a chance for a healthy result. PATIENT GROUP: It has been reported in some developed countries that as much as 40-50% of the feline population may be overweight or obese, with middle-aged cats, male cats, mixed-breed cats and neutered cats being at greatest risk. AUDIENCE: This review of what is currently known about the health risks, predisposing factors and treatment of excessive weight gain in cats is aimed at all veterinary health professionals. EVIDENCE BASE: The information reported in the review is drawn from the current scientific literature as well as from the clinical experience of the authors.     

Bartonellosis in cats: a role in uveitis?

Bartonellosis has been widely studied in human and veterinary medicine over the past two decades. Despite this fact, it remains an enigmatic disease in many ways. The causative bacteria, Bartonella spp, are transmitted to cats by fleas and thus the prevalence in cat populations, particularly in temperate climates, is high. Most cats, whether infected naturally or experimentally, remain asymptomatic. Thus, correlating the presence of the organism to clinical disease, including uveitis, in cats has been difficult. This review summarizes what is known of the transmission and pathogenesis of Bartonella spp in cats, the possible role of the organism in feline ocular disease, as well methods of diagnosis and treatment.