Handling cats: to minimize stress in Cats (Felis) | Vetlexicon
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Handling cats: to minimize stress

ISSN 2398-2950

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Introduction

  • Most cats are fearful and/or anxious at the veterinary clinic. Simple changes can make a big difference in the stress level of feline patients resulting in less restraint, less bites and happier patients and clients.
  • Strategies include flexibililty in location and structure of the physical examination, type of restraint and judicious use of anti-anxiety medication.

Examining the patient

  • Having ‘cats only’ examination rooms help to reduce stress because there is less exposure to the smells and vocalizations of other species, eg dogs. In addition, cat only examination rooms can accommodate the special needs of cats to hide and retreat to high spaces Cat friendly clinic programs
  • The following tips may help to prevent fear:
    • Play low volume classical music in the examination room.
    • Play white, brown or pink noise just outside of the door to reduce hospital sounds.
    • Speak softly.
    • Sit down.
    • Talk to the clients first while allowing the cat to accommodate to the surroundings.
    • Dim the lights and, preferably, use targeted lighting as needed. 
    • If there is lots of natural light in the room, give feline patients a way to rest and look out of the window. 
  • Roles for odors:
    • Cats are exquisitely sensitive to odors and mark primarily with urine, facial and body secretions. As a result, they are sensitive to the olfactory environment of a veterinary hospital.
    • Air out rooms as much as possible between patients.
    • Use disinfectants that do not have strong odors followed by air drying.
    • Standard bleach solutions are 5.25% sodium hypochlorite or less (the brand name Clorox is standardized to 5.25%). For routine disinfection of surfaces a 10% by volume dilution (0.525%) is recommend by brand name bleach manufacturers. 1% solutions are used as rinses to sterilize tissues, including nasal tissues, but contact is not prolonged and pH matters. If olfaction is how you get your information, loss of olfactory neurons is a stressor and will render the patient more, not less anxious. Hence, smart management of such solutions matters.
    • Accelerated hydrogen peroxide disinfectants are equally efficacious and gaining in popularity.
  • Administering tests/treatment:
    • If the cat willingly walks out of the carrier or is able to be taken from the carrier without undue stress or distress, physical examination can usually be accomplished.
    • As with all patients, struggle and stress are lessened when the patient can be examined in natural postures (standing, on your lap, the client's lap or in the carrier).
    • Examination should be a natural part of the flow of conversation and history taking. If the cat struggles or is distressed, allow the cat to go back into the carrier or take a break from examination allowing the client to hold their pet.
    • Painful physical restraint is frightening and unnecessary. Many patients can be managed with a more cautious approach. If the patient cannot be managed with a low stress restraint, consider sedation.
    • With butterfly catheters, blood samples are easily obtained and an adaptor sends the blood directly to the tubes, eliminating a step and reducing the risk of venous collapse associated with syringes.
    • If the cat is distressed and the test or procedure is not a medically urgenct, discuss anti-anxiety medications or some level of sedation with the client so that the cat is able to have the kind of medical care he or she deserves.
    • Make a note of the type of restraint used, food offered and location of the physical examination so that successful procedures can be repeated reducing stress to the patient.

Pharmacologic intervention

  • Medication is commonly used to alleviate fear, anxiety and distress in feline patients Therapeutics: behavior modifiers.
  • Administer medications 2-3 hours prior to appointment time. In addition, some medications (trazodone, gabapentin) may be more efficacious if administered the day before and 3 hours prior to the appointment time.
    • Benzodiazepines Diazepam (alprazolam, midazolam Midazolam, lorazepam).
    • Gabapentin Gabapentin.
    • SARIs (trazodone).
    • Clonidine Clonidine.
    • Notes:
      • All of these medications with the exception of clonidine can be used with Dexdormitor Dexmedetomidine (an alpha agonist) and Anti-sedan (an alpha antagonist).
      • Each medication listed above can be administered up to every 8 hours.
      • The response to psychotropic medications is individual and multiple trials will most likely be necessary to find the most effective dose for the patient. 
      • Medications such as alprazolam can be given as close as 30 minutes prior to the time of examination however, they will not be as effective if the patient has already mounted a stress response.
  • For mild sedation for cats:
    • Chlorpheniramine Chlorphenamine 2-4 mg/cat PO q12-24 h.
    • Trazodone 25-50 mg/cat.
    • Gabapentin 100-200 mg/cat.
Dosages
Medication Cat
Alprazolam 0.0125-0.025 mg/kg PO to start;
this is ¼ of a 0.25 mg tablet for tiny cats
Chlorpheniramine 2-4 mg/cat PO q12-24 h
Gabapentin 100-200 mg/cat 3 h before an appointment
Lorazepam 0.05 mg/kg PO q12-24 h up to 0.125-0.25 mg/cat;
start low….starting range reported at 0.03-0.06 mg/kg;
smallest tablet is 0.5 mg
Midazolam 0/05-0.3 mg/kg but….SQ, IM or IV, only and
more for sedation than anxiety
Trazodone 25-50 mg/cat

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mariti C, Guerrini F, Vallini V et al (2017) The perception of cat stress by Italian owners. J Vet Behav: Clin Appl Res 20, 74-81 VetMedResource.
  • Hammerle M, Horst C, Levine E et al (2015) 2015 AAHA Canine and Feline Behavior Management Guidelines. JAAHA 51 (4), 205-221 PubMed.
  • Rodan I, Sundahl E, Carney H et al (2011) AAFP and ISFM feline-friendly handling guidelines. J Feline Med Surg 13 (5), 364-375 PubMed.
  • Pizzorusso T (2009) Neuroscience. Erasing fear memories. Science 325 (5945), 1214-1215 PubMed.
  • Overall K L, Rodan I, Beaver V et al (2005) Feline behavior guidelines from the American Association of Feline Practitioners.​ J Am Vet Med Assoc 227 (1), 70-84 PubMed.

Other sources of information

  • Overall K L (2013) Manual of Clinical Behavioral Medicine for Dogs and Cats, Elsevier.

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