Feline patients are notoriously challenging: some are difficult to handle, others become so stressed at the vet their blood glucose skyrockets, and the mere scent of a vet is enough to manifest profound physiological changes including pyrexia, tachypnoea and dyspnoea. But according to feline specialist Andrea Harvey, there is much the average vet can do to make cats more comfortable.
Harvey, a UK-qualified feline specialist who relocated to Australia last year, has been working in conjunction with the International Society of Feline Medicine (ISFM) on its ‘Cat Friendly Clinic’ scheme since 2005.
The program is designed to provide veterinary clinics with educational resources to reduce the stress to cats visiting the vet, and acknowledging veterinary clinics that do make measures to make their clinics as least stressful as possible for cats.
“None of this is really rocket science,” Harvey said. “But I think that often as vets we are good at focusing on complex problems and missing the small simple things that make a big difference, and I am absolutely adamant that this forms an essential foundation for feline medicine.”
Harvey graduated from Bristol University in 2000, when feline medicine was in its infancy (the Journal of Feline Medicine and Surgery, now the go-to publication on any feline affliction, was launched in 1999).
“I was exceptionally lucky to be mentored and inspired as an undergraduate by feline specialists such as Tim Gruffydd-Jones and Andy Sparkes around that time,” she said. “When I went out into practice I realised how much cats were still being treated like small dogs and second class citizens, and I just wanted to do a better job with them than that.”
It is said time and again that cats are not small dogs. For Harvey the differences between the species are vitally important – from the dietary requirements of cats, to diseases they suffer from, the drugs used to treat them and how they metabolise drugs.
“A lot of the most common cat diseases that we see are unique to the cat,” she said. “For example hyperthyroidism, idiopathic cystitis, gingivostomatitis and an array of feline infectious diseases.”
“On a day to day basis though, one of the most important differences that is so simple but so frequently overlooked in veterinary practice is their psychological/behavioural differences and the consequences of those. We all know that cats can be difficult for the client to bring to the vet, and difficult for them to medicate. So unless we get these basics right we won’t get many feline patients coming through our practice door, and continuing to come back!”
Harvey undertook a residency in feline medicine at Bristol, sponsored by the ISFM – an organisation for which she now acts as the Australasian representative.
She said that stress results in so many changes in cats from changes in behaviours, to parameters that we are measuring to diagnose and monitor illness.
“Cats are solitary hunters, they are territorial which means they are strongly bonded to their home environment and feel very unsafe in unfamiliar environments, they are scent sensitive and changes to their ‘home’ scent are upsetting and they communicate largely by scent to avoid confrontation with other animals,” Harvey said.
In other words, a trip to the veterinary clinic has all the makings of their worst nightmare. Any change in the environment – the presence of other animals, noise, smells and general sensory overload can lead to profound anxiety in the feline patient.
“They are highly aware of sights, sounds and smells that we are often unaware of, and are very emotional animals – their emotions can change very quickly,” Harvey said.
Any veterinarian knows too well the seemingly tractable cat who suddenly “goes feral”.
For cats, stress is exacerbated when they can’t exercise their preferred coping mechanism – running away and hiding.
“Cats are easily frightened by anything new and immediately will think that the worst is going to happen to them,” Harvey said. “Through our actions in the veterinary clinic, we need to alleviate that fear and not confirm it.”
Stressed out cats make for stressed out owners – which is the number one reason, according to studies, for cat owners to avoid vet visits.
And when they do turn up they don’t make diagnosis a walk in the park.
“Once at the vets, a stressed cat may be more difficult to handle, may exhibit fear aggression and be difficult to examine or take blood samples from,” Harvey said. “Those that you do examine may be tachypnoiec, tachycardic and pyrexic, simply as a result of stress.”
Even if you can run tests, stressed out cats may be hypertensive, hyperglycaemic, even alkaluric. Allowing the patient to “chillax” in hospital doesn’t necessarily improve the situation. Anxious cats may refuse food and avoid toileting – especially when you’re waiting for a urine or stool sample.
“When we are trying to diagnose illness, monitor illness, and monitor and treat pain, we can’t possibly do a good job if a cat is stressed and all of these vital parameters are so heavily influenced by stress,” Harvey said. “This is what I mean when I say that this all forms the basis of feline medicine. We simply can’t begin to practice good feline medicine until we can address these factors.”
The good news is that the majority of factors that lead to feline stress can be overcome.
An ISFM accreditation scheme for Cat Friendly Clinics was launched in the UK before being rolled out in the Europe and the US. The scheme has just been launched in Australasia with the support of Royal Canin and CEVA.
Cat-friendly clinics facilitate a higher standard of medicine by enabling veterinarians to detect and monitor subtle changes.
There are other benefits.
“When clients notice the difference in their cat’s behaviour at the vets they start coming to see you a lot more,” she said.
“It is essential to adopt a really holistic approach with cats – you can’t just put things in boxes and focus on medicine, or surgery – you have to always look at the bigger picture with cats and also consider their behavioural psychology at every step.”
That includes the home environment, the journey to and arrival at the clinic, the consultation, hospitalisation and discharge.
The first Australian clinic to become ISFM gold standard cat-friendly accredited was the Small Animal Specialist Hospital (SASH), where Harvey consults.
It has been a busy year for Harvey, who – since relocating to Australia with her horse and cat – joined the SASH team and launched the ISFM scheme at the same time. She also co-edited The BSAVA Foundation Manual of Feline Practice with Severine Tasker. She spoke at conferences in Bangkok, Amsterdam, Budapest, Hong Kong, Auckland and the UK at BSAVA.
Harvey was recently honoured with the BSAVA Woodrow Award for contributions in feline medicine.
“I would like to think that this is largely a testament to the genuine difference that the ‘cat friendly clinic’ scheme has made to the standards of feline medicine in the UK,” she said.
She is also a tutor on the joint CVE (Centre of Veterinary Education)/ISFM distance education course in feline medicine.
“In my clinical job at SASH I am passionate about providing the best care for all my feline patients, but of course on a big picture scale that is such a minority of cats that I personally treat. What really drives me to do other work outside of that is trying to inspire and pass on any knowledge and skills that I gain from my patients, to other veterinarians across the world, to try and provide as many people as possible with the tools and passion to provide the best care for their feline patients too.”
Harvey’s passion for animals extends well beyond the feline. Together with her partner she has a menagerie of sheep, alpacas, goats, birds and horses. Earlier this year she adopted three yearling brumbies rescued from the Guy Fawkes National Park by Save the Brumbies Inc.
Harvey’s top three tips for enhancing the feline-friendliness of any veterinary clinic are extremely simple but effective:
Minimise exposure to noise, dogs, and general ‘activity’ during hospitalisation. “Go slow to go fast – in other words, making haste is less efficient when it comes to cats,” Harvey said.
Provide cats with a place to hide wherever possible, such as a bed or box. This can be achieved during a consultation by examining a cat while it is mostly contained in the bottom half as a cat carrier. “I have been told by clients on several occasions that the reason they come to see me is simply because I was the only vet they had seen that removed the top of the cat carrier and examined the cat within the bottom of it, rather than dragging it out the front of the carrier – its little things that make the differences!)” Harvey said.
Always utilise gentle handling and minimal restraint, for example by using bedding to minimise direct physical contact.
To find out more about accreditation, visit this site.
Pictures Andrea Harvey