Getting to grips with cat handling

Cats are easily stressed in the practice environment and this can affect their health and behaviour.

Simple changes can dramatically improve practice-patient interaction, making the experience better for staff, pet and owner. These may include alterations to equipment or the structure of the clinic, but the most important is education of staff.

A large part of this article is derived from the American Academy of Family Physicians (AAFP) and International Society of Feline Medicine (ISFM) feline-friendly handling guidelines by Roden et al (2011), published in the Journal of Feline Medicine and Surgery and freely available from a variety of sources.

Adapting these guidelines to each individual cat can lead to:

• reduced pain and fear for the patient
• reinforced vet-client-patient bond, trust and confidence and improved lifelong medical care for the cat
• improved efficiency, productivity and satisfaction for the veterinary team
• increased client compliance
• early detection of medical and behavioural problems
• fewer injuries to clients and the veterinary team
• reduced client anxiety

Feline behaviours

The education of clients in regards to the behavioural characteristics of cats will help them understand how to interpret behaviours from the animal’s perspective.

It is important to understand, unlike dogs, cats are not a naturally social species and are highly territorial. This means they feel both vulnerable and threatened when removed from their normal environment (Sparkes, 2013).

Cats are solitary animals, avoiding confrontation with other cats wherever possible. Avoidance or hiding is often the initial response, with fighting occurring as a last resort. Therefore, allowing cats to remain protected and hidden while at a veterinary practice and improving utilisation of towels and carriers can improve handling.

Recognising fear and anxiety is essential to take steps to reduce escalation to fear aggression. Ear position, body posture and tail movements are helpful indicators of a cat’s state of mind. Facial and eye changes can indicate increasing anxiety. Increased sweat may be produced from the paws and vocalisation may occur in the form of distress meowing to growling, hissing or spitting.

Cats lack techniques to resolve conflict by appeasing each other and resort to freezing, fleeing, fighting or displacement behaviours.

Ensuring a sense of safety and security is the ultimate goal for managing feline patients. When this does not occur, cats display behaviours associated with fear or aggression. Both fear–induced withdrawal and aggression make treatment difficult.

A cat that freezes is signalling it is anxious or uncomfortable. It does not move, eat or drink and may appear to not require care, when, in fact, the opposite is true.

The aggressive cat may vocalise, bite or scratch as it feels it has no other options in how to react.

The ultimate goal is to make feline patients feel content through appropriate care and handling. In addition, stress can impair recovery from illness or injury (Carney et al, 2012).

Unfamiliar circumstances cats encounter in veterinary clinics may lead to the adverse effects of anxiety and fear. These adverse effects suppress normal behaviours (such as rest and feeding) and increase vigilance, hiding and dysfunctional signs, such as anorexia, vomiting and diarrhoea, or even lack of elimination.

Undesirable physiologic responses to stress include:

• hyperglycaemia
• decreased serum potassium concentrations
• elevated serum creatinine phosphokinase concentrations
• lymphopenia
• neutrophilia
• erratic response to sedation and anaesthesia
• immunosuppression
• hypertension
• cardiac murmurs

These changes can complicate clinical evaluation and treatment of cats, and prolong hospitalisation (Carney et al, 2012).

Preparation for a veterinary visit

Making the time to accustom a kitten or cat to travel and handling can reduce the stress of veterinary visits long term.

The veterinary team and client need to work together to provide positive veterinary experiences. This can be done by:

• A rehearsal of visits to the practice using positive rewards to introduce the cat to the practice, being around other cats and people.
• Offering various client education classes.
• A rehearsal of clinical examinations at home. Owners can perform simple examinations at home using positive reinforcement, such as handling paws, looking in ears and opening mouths.
• Understanding the effect of our own anxiety on the cat.
• Proceeding at the cat’s pace and being aware of its responses, using rewards where needed.

Getting ready to leave home

Preparing the cat for a veterinary visit should start at home.

Leaving the carrier permanently in the environment with familiar bedding allows the cat to become used to the presence of the carrier and use it as a safe place.

This is much less stressful than presenting a carrier the cat only associates with transport and stress, that smells unfamiliar or has been stored unfavourably, or has been used to transport other animals in.

Using a synthetic feline facial pheromone (FFP) analogue spray at least 30 minutes before transport can help calm the patient.

Ensure the carrier is secured within the vehicle, as moving carriers can frighten the cat and placing a familiar towel over the carrier can prevent visual stimulus.

Preparing a practice environment

Key considerations for creating a cat-friendly environment are:

• Manage odours. Cats are microsmatic – their sensitive sense of smell drives many of their behavioural responses.  Some odours (such as disinfectant, blood and deodorant) may cause anxiety and fear. Ensure all surfaces are clean and areas ventilated.
• Consider using a synthetic FFP analogue. Studies show these may have calming effects in stressful environments. Cats may benefit from diffusers placed throughout the hospital and a spray used 30 minutes in advance on material used for bedding and handling.
• Manage visual and auditory input. Minimise scenarios that may lead to anxiety and keep other patients away from the cat’s line of vision.

Preparing the practice environment must include all areas the patient may visit, such as the car park and distance the owner needs to walk to get into the practice.

Waiting times should be minimised. If possible, cat appointments should be made for quieter periods of the working day, and cat and dog appointments should be at different times.

Ideally, there should be a separate feline entrance and waiting area. If this is not possible, minimise the interaction of cats with other animals and educate owners to keep dogs away from feline patients.

Screens can be used to separate areas and clear signposting can help direct clients.

Tables or other level surfaces can be provided to place the carrier so the cat is not on the floor. If possible, cover the carrier with a familiar towel or have towels available in the reception area to use, but ensure they are not swapped between cats as this will allow scent signals to transfer between patients.

A minimum of one exam room should be dedicated to cats only. This should provide a number of surfaces in addition to the examination table where the cat can be comfortable, such as a chair or windowsill.

Conduct the exam wherever the cat appears most comfortable. To remove a patient’s scent signals, use disinfecting soaps that remove protein and fat (both part of the component of pheromones). Having a variety of food treats, disposable toys or catnip can help positively engage the cat.

Cat-only rooms in the kennelling area should be provided.

Ideally, the cage should be large enough to accommodate the carrier and for the litter box to be away from food, bedding and water.  Alternatively, provision of a cardboard box or other safe haven with hiding and perching areas can be supplied.

Side-by-side cages are preferable to those facing each other as this reduces visual stimulus. Mid-level or higher cages are preferable to those close to the floor.

The temperature and noise level should be controlled; fibreglass cages are warmer, less reflective and quieter than stainless steel.

Cats perceive light in greater abundance than humans due to the tapetum lucidum, so softer lighting should be considered.

Studies have shown classical music can increase behaviours associated with relaxation in animals (Herron and Shreyer, 2014). The cage should contain toys or bedding from home and consideration to the cat’s litter and food should be given.

The type of litter tray should also be considered. Elderly patients may benefit from a flat litter tray to aid entry and exit. Adjust the cage for each individual rather than just using a standard set-up.

Interaction with felines in practice

At every stage of the practice visit, adopt a team approach, monitoring for stress (Carney et al, 2012).

Greet cats and owners with moderated body language and voice.

Be aware of any special requirements such as soft surfaces for patients with arthritis. Be prepared with equipment readily at hand to minimise the length of examination and noise associated with looking for items. Use a slow approach with a calm, positive demeanour.

Open the carrier door while taking the history so the patient can choose whether it wants to venture out. If the patient is still in the carrier once the history has been taken, quietly remove the top and door if possible, as most cats are comfortable to remain in the bottom half of the carrier for the bulk of the examination.

If the cat still appears anxious, a towel can be placed between the two halves of the carrier as the top half is removed. This covers the cat, but allows examination.

If the carrier cannot be disassembled, avoid grabbing the cat or tipping the carrier. Reach in and support the caudal abdomen and back legs to encourage the cat to move forward.

If the cat is reactive, gently place a towel around the patient to remove it.

It is important to recognise cat signals to determine our own behaviour. If the cat exhibits signs of fear, slow down or take a break from handling. Some patients will become worse regardless and may require sedation for examination or anti-anxiety medications, for example, benzodiazepines.

Hospitalisation for additional procedures later in the day being rescheduled may be necessary.

A variety of techniques can be used for each patient. These include:

• The usage of towels or anti-slip mats under the cat or, ideally, bedding from the carrier.
• Examine the cat in a lap with the cat facing towards the client and away from the examiner, using your body and arm to support the cat.
• Allow the cat to maintain its chosen position.
• Vary your touch with the cat’s response. Massaging the cranial aspect of the ears or between the eyes can help calm the cat. Most cats prefer the head and neck for physical touch and may become upset or aggressive if petted in other areas.
• Swaddle the cat in a towel or cover the head with a towel.
• Wherever possible, perform procedures in the exam room.
• Avoid direct eye contact.
• Move slowly and deliberately, minimising hand gestures. Use quiet voices and encourage the owner to do the same. Avoid loud noises or ambient sounds that may mimic hissing, such as whispering.
• Put yourself on the same level as the cat, do not loom above or over it and approach from the side.
• If the cat is anxious, return it to the carrier as soon as possible and continue to talk to the owner while the cat is in its safe place.
• If medical procedures are needed, begin with those less stressful or invasive (Vogt et al, 2010; Roden et al, 2011).

To scruff or not to scruff?

Scruffing is a general term for a variety of holds on the skin of the cat’s neck.

Opinions on this topic vary widely, with some vets choosing to never use the technique and others happy to use it if necessary to physically protect personnel or for short procedures.

Many other gentle techniques are less stressful to the patient, while still being time efficient and safe for personnel.

Towels or muzzles that cover eyes can reduce visual stimulus, while preventing a cat from biting members of staff. Gloves and cat bags can also be used, although these can be awkward to use in a practical setting.

Scruffing should not be used as an alternative to good technique and sympathetic handling.

Going home after a veterinary visit

When cats return home they may carry unfamiliar materials, such as bandages or odours from the practice.  This may create problems with other cats in the home.

Using familiar bedding and synthetic FFP analogs can help reduce this, as well as adopting a passive approach when bringing the cat home; for example, not forcing cats together and keeping key resources apart.

In summary, optimal cat handling techniques and adjustment of the practice wherever possible have significant benefits in terms of patient stress and improved client bonding.

Serious injury can occur to staff members and owners through inappropriate handling. Trust and bonding can be irreparably broken during a single examination by unsympathetic handling. Therefore, it makes good ethical and financial sense to improve feline handling in the veterinary practice.

Education of personnel and clients is key, so encourage team members to use language such as unhappy or frustrated, rather than naughty or aggressive, so they start to look at the patient sympathetically.

• Some drugs mentioned in this article are used under the cascade.