Page 924 - Small Animal Clinical Nutrition 5th Edition

956 Small Animal Clinical Nutrition

VetBooks.ir Box 46-5. Ancillary Management for Patients with Feline Idiopathic Cystitis:
Environmental Enrichment.

In addition to nutritional management, currently recommended treat- resolve, cats may not return to their previously friendly relationship.
ment for patients with feline idiopathic cystitis (FIC) includes environ- In serious cases, full segregation and gradual reintroduction using
mental enrichment, stress reduction and appropriate litter box main- desensitization and counter-conditioning may be necessary. Cats
tenance. Recently, a prospective, uncontrolled study evaluated the with persistent periuria can be very frustrating to manage and may
effects of multimodal environmental modification in 46 client-owned be relinquished to a shelter if not handled appropriately. Therefore,
cats with FIC. Significant reductions in lower urinary tract signs, fear- consulting with a veterinary behaviorist (sooner rather than later)
fulness and nervousness were seen after treatment for 10 months, should be considered to increase chances of improving quality of life
compared with the signs noted before using environmental enrich- for the cat and the owner. Boxes 46-6 and 46-7 provide more infor-
ment. mation about behavioral management of cats with inappropriate uri-
Environmental enrichment includes providing opportunities for nation.
play/resting (e.g., horizontal and vertical surfaces for scratching, hid-
ing places and climbing platforms). Food and water bowls should be PAIN MANAGEMENT
clean and kept in safe places (e.g., not next to noisy appliances). Analgesics are indicated to manage patient discomfort during acute
Litter boxes should be clean and kept in locations that do not episodes of FIC. Drugs that have been used include buprenorphine a
increase stress. An adequate number of litter boxes (generally (0.03 mg/kg body weight administered topically via buccal mucosa
b
defined as one more than the number of cats in the home) should be every six to eight hours), butorphanol (0.5 to 1 mg/kg body weight
c
available. Most cats prefer clumping, unscented litter but individual orally every six to eight hours) and meloxicam (0.1 mg/kg body
preferences may differ for some cats and different strategies can be weight orally once daily for three to four days). Although other anal-
used to determine a cat’s particular preference. More detailed and gesics and nonsteroidal antiinflammatory agents may be appropri-
helpful information about environmental enrichment and litter box ate, selection is often based on clinician preference or experience
management is available elsewhere. and whether the patient has concomitant conditions (e.g., kidney dis-
ease) that might preclude their use. No clinical studies have evaluat-
BEHAVIORAL MANAGEMENT ed opioid analgesics (e.g., butorphanol, buprenorphine) or nons-
Even after successful implementation of strategies described above, teroidal antiinflammatory agents in patients with FIC.
some patients with FIC (or other lower urinary tract disorders) may
continue to urinate in inappropriate locations. This undesirable FELINE FACIAL PHEROMONE
behavioral pattern may be maintained for several reasons. Classic Synthetic feline facial pheromone therapy has been recommended to
conditioning may play a role in persistent periuria. The litter box is decrease signs of stress in patients with FIC. In a double-blind,
associated with pain and discomfort that occurred when the cat uri- placebo-controlled clinical study of 20 hospitalized cats (13 with
nated in the box previously; therefore, the cat might associate this lower urinary tract disease and seven apparently healthy), exposure
d
experience with the litter box and avoid using it in the future. In this to feline facial pheromone was associated with significant increas-
situation, it may help to change the location or physical characteris- es in grooming, interest in food and food intake; these results sug-
tics of the litter box. It also is possible for cats to develop a litter box gested an anxiolytic effect in some cats. Another study evaluated
aversion secondary to lack of cleanliness, because the litter box may effects of feline facial pheromone in 12 patients with FIC. Although
be used more frequently during episodes of FIC. If this happens, it no significant difference was seen between treatment of the environ-
may help to provide additional litter boxes and/or increase frequen- ment with placebo and feline facial pheromone for two months, a
cy of cleaning the litter box or changing litter. If a cat develops a lit- trend was identified for cats exposed to facial pheromone. Exposed
ter box aversion secondary to FIC or experiences an urgency that cats had fewer days with clinical signs of cystitis, a reduced number
causes elimination elsewhere, the possibility exists for development of episodes and reduced negative behavioral traits (e.g., less aggres-
of a secondary location or substrate preference. In this situation, the sion and fear). Further study is needed; however, it seems reason-
litter box is not necessarily the problem; however, the cat may dis- able to consider treatment with facial pheromones in cats with signs
cover a better toileting option (e.g., a substrate that is softer, more of stress or when clinical signs persist after implementing environ-
absorbent, more accessible or cleaned more readily). To resolve this mental enrichment and methods to increase water intake.
problem, the preferred inappropriate site should be made less attrac-
tive or unavailable while the litter box is improved to meet the pref- GLYCOSAMINOGLYCANS
erences of the cat. Finally, the pain associated with an episode of FIC Glycosaminoglycan (GAG) replacers such as pentosan polysulfate
may result in increased irritability and subsequent social strife have been used in people with interstitial cystitis and have been rec-
between previously friendly cats in the household. When signs of FIC ommended for patients with FIC. Anecdotally, these agents have

to values ranging from 1.032 to 1.041 (Markwell et al, 1999; managing these uroliths should be considered for cats with
Gunn-Moore and Shenoy, 2004). It is not known if FIC pre- FIC. Tables 46-19 and 46-22 provide key nutritional factor
disposes to urolith formation, but the presence of inflammato- information about selected veterinary therapeutic foods for
ry cells and other products of inflammation could conceivably managing patients with FIC compared with recommended lev-
pose such a risk. Foods that are most similar to the key nutri- els of key nutritional factors. When possible, moist foods
tional factor target ranges and/or have the best evidence for should be selected over dry foods.