Getting started: the wellness exam
To achieve optimum feline health care, veterinarians must help owners to understand and appreciate the importance of regular preventive care for their cats at all ages. A consistent message from the entire health care team is crucial, beginning with the first kitten visit and reinforced during subsequent visits. Early detection of clinical abnormalities and behavioral changes can improve disease management and quality of life.5,6
Figure 1 — The benefits of regular wellness exams often are not immediately apparent to pet owners and need to be well explained. Courtesy of Ilona Rodan.
The panel supports the recommendations of the American Association of Feline Practitioners (AAFP) and American Animal Hospital Association (AAHA) that a minimum of annual wellness examinations and consultations for all catsis justifiable. More frequent examinations may be recommended for seniors and geriatrics, and cats with medical and behavioral conditions.
Semi-annual wellness exams are often recommended for all feline life stages by veterinarians and veterinary organizations. Their reasoning includes the fact that changes in health status may occur in a short period of time; that ill cats often show no signs of disease; and that earlier detection of ill health, body weight changes, dental disease, and so on, allows for earlier intervention. In addition, semi-annual exams allow for more frequent communication with the owner regarding behavioral and attitudinal changes, and education about preventive health care. Further research is needed to identify the optimal examination schedule to maximize the health and longevity of the cat.
According to one study, 41% of people looking for their lost cats considered them to be indoor-only pets.9 American Humane Association records reveal that only about 2% of lost cats ever find their way back from shelters, a major reason being the lack of tag or microchip identification. Assuring the identification of all pet cats, regardless of their lifestyle, is recommended to increase the prospect of lost cats being returned to their owners. The wellness examination is the ideal time to discuss the importance of identification with owners. The benefits of both visible (eg, collar and tag) and permanent (microchip) identification should be explained and compliance with identification recorded in the medical records along with other elements of the history.
The panel members concluded that preventive veterinary care can improve quality of life, detect illness earlier and, therefore, reduce the long term expenses associated with a cat's health care. They believe that cat owners are willing to seek more veterinary care when it improves quality of life and detects illnesses earlier, thereby reducing the long term expenses associated with their cat's health care. Improved client communication and education of the benefits of regular veterinary care are essential to achieve that goal (Fig. 1).
The reasons pet owners have cited for not seeking care were that they did not know it was necessary, the veterinarian did not recommend it, and the need or benefit was not well explained.7 Other obstacles include the cat's stress or fear associated with veterinary visits and the practical difficulties of transporting cats to receive veterinary care. Suggestions for overcoming such barriers are provided here.
It is not the intent of the panel to reiterate the basics of the veterinary visit, but instead to offer a checklist to assist the veterinarian (see Table 1). Where relevant, aspects of feline behavior, nutrition, and various disease prevention and detection strategies are expanded on in the text.
History-taking includes the use of open-ended questioning (eg, 'How has [cat's name] been doing since the last visit?').8 This approach is often combined with a template or checklist, such as given in Table 1, to ensure important aspects are not overlooked.
When performing the physical exam, particular attention should be paid to:
- Observing the cat from a distance to assess breathing patterns, gait, stance, strength, coordination and vision.
- Changes in parameters from prior exams (body weight, body condition score [BCS], vital signs).
- Other specifics as noted in the discussion/action items in Table 1.
The minimum database
Although specific data documenting benefits are not available, the panel concluded that regular wellness examinations and collection of the minimum database (MDB; Table 2) can be valuable, allowing early detection of disease or trends in clinical or laboratory parameters that may be of concern. Additionally, it provides a baseline for interpretation of data recorded at subsequent visits.
Figure 2 — Regular assessment of weight and body condition score is important in cats of all ages–and this needs to be stressed to owners. Expressing any changes in weight as a percentage, or in terms of an equivalent weight loss/gain in humans, can be helpful. Courtesy of Deb Givin.
Specific recommendations about age and frequency of laboratory testing depend on many factors.5,18,24 One consideration in determining this frequency is that the incidence of many diseases increases as cats age. Guidelines for management of mature, senior and geriatric cats may be found in the AAFP Senior Guidelines.5Retroviral testing is discussed in detail in the AAFP Retrovirus Testing Guidelines.22 Measurement of blood pressure is discussed in detail in the ACVIM guidelines.25 Although limited incidence studies have been performed to identify the age of onset of hyperthyroidism in cats, the panel recommends that veterinarians strongly consider T4 testing in the apparently healthy mature cat. More robust incidence data is needed to develop firmer recommendations.