Latest / Senior Pet Talk | for dogs + cats / 8. What to Ask at Your Senior Cat's Vet Visit

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8. What to Ask at Your Senior Cat's Vet Visit · Senior Pet Talk | for dogs + cats

• Amanda Steffen: You are listening to Senior Pet Talk, the show where we combine Western and Chinese medicine to give senior dog and cat parents the knowledge, the clarity, and the confidence to make sure that your pets' senior years are their best years yet. I'm Dr. Amanda Stefan. Let's get started. Hello, senior pet parent. Thank you for tuning in today. If you are new here, my name is Dr. Amanda Stefan. I am an integrative veterinarian who blends Western and Chinese medicine together to give you all the options for your senior dog or cat. And today I am very excited to talk to you about senior cats specifically. I believe that senior cats are very much under Discussed in medicine. There's a joke that I have with a couple people that cats are kind of like the women of medicine. So if you don't know, there's not a lot of data and studies on women because apparently we're too complicated for medicine to figure out a study around us. So a lot of medicines and treatments and things like that are all focused on men because they're easier, I guess. And same thing with cats and dogs. Cats are often not studied in a lot of things because they are a little bit harder to do certain studies on. So I spend a lot of my time trying to find any data on cats and pull all that information together because we're in a generation now where cat parents are willing to do anything to help their pet, right? I think it used to be a little bit different historically with cats, but at this day and age, like our cats are our babies. Like they're our children for a lot of us. And we want the opportunity to do all of the treatment options that we can for them and that we see all these dogs getting access to and we don't have access to them. Right. So If you are watching on YouTube or you hear any snoring, I do have my little Frenchie here. He's actually usually pretty quiet because I have had his face fixed, but I just want to let you know in case you hear anything. Today I want to talk to you about when you go in for a veterinary visit with your senior cat. What should you be asking? What should you be advocating for? And what tests should we be running? Now, my best friend, who is also a veterinarian and one of the people who mentored me, he says this in a wonderful way that I appreciated and have kind of taken into my own. When we talk about senior pet care, it is an investment and it needs to be a conversation that us as practitioners have with pet parents. That if you want to do all the things That we probably need to do once or twice a year, which means diagnostic testing wise, then it is going to be a couple hundred dollars up to a thousand dollars every six to twelve months. And that is very daunting and I understand that. However, if we know that ahead of time, then we put $50 away a week and we're there very quickly, right? I know that's easier said than done. I get it. However, I believe that we should focus more on having abundance mindsets in life. And that's a whole different conversation. But anyways, just know that the things that I'm gonna go over today typically do cost money. And it is one of those things that we do have to understand there is an investment involved with this. And there's a trade off always. So when we're talking about our senior cats, we know there's going to be a trade off here, right? So there is going to be an expense associated with the care that we would like to do every six to twelve months, the things that we would like to check. If that is not feasible, which it won't be for a lot of people, I grew up in a place where that would have not been feasible. Then we Just have to understand, maybe we talk about what the most important tests are today and how we can plan out future tests, or based on their clinical signs, what would be the most important test that your veterinarian can think of to do right now? So, as practitioners, we really enjoy getting to piece everything together. Our patients can't talk to us, right? So it's always something where we're trying to navigate and put all these little puzzle pieces together. A lot of it comes from a really good history. And then we get certain diagnostics that we're able to add into that. And it usually helps. Okay. So there are a couple of things that happen in cats that I want you guys to know about. And I think it's not something to scare you in any way, but being prepared, this entire podcast and my entire purpose in senior pet care is to prepare you so that you know what things look like and you can go to your vet when they first happen. I want you to be able to catch things early. So many diseases that we see, so many things that we treat could have been treated faster with less stress or pain on our pets, and usually cheaper if they were caught earlier. And that's no one's fault. You just don't know what you don't know. And that's what I'm here to do. I am basically making you like mini specialists on your senior pet. And the most important part of their care team is you. You are the most important part of their care team. A hundred percent. So cats are very silent creatures for the most part. They're not going to walk up to you and start yowling about something. They're just gonna stop doing things. They're gonna stop going to bed with you. They're gonna stop making it all the way into the litter box. They're gonna stop going up and down the stairs. They're gonna stop getting up and off the furniture. They're gonna stop eating just a little bit that you barely notice. They're gonna have these very subtle changes. You're gonna notice a little bit of weight loss. Maybe they look a little thinner, but we don't typically see these. big drastic changes in cats until we're in an end stage of organ disease. I see this all the time working in emergency medicine. I work in an ER in the weekends and we see cats that come in all the time and their parent will say, well, they were fine two days ago. And now they're in heart failure and have free fluid in their belly and all this other stuff going on. And I don't doubt at all that they weren't showing any signs before that. No big signs that you would have actually picked up on. Because we all have lives. We have to go to work. We have to do other things. We don't always pick up on these very tiny changes. So that's what I'm here to teach you. And so that you know better and you can help your pet before all these things change. Okay. So they are very good at masking illnesses. This is a survival instinct. We all know this, like predatory prey thing. So these subtle signs is there's just going to be like a couple of pieces left of kibble in the bowl. They're gonna be drinking from the fountain of lip but more a little bit less. There's they're gonna have an increase or decrease in their bathroom breaks and things like that. They're gonna wake up more at night or start yelling around the house, or maybe they like start running into a wall or something, seem like they're a little confused or can't see even. That is one of the things that we see. So chronic kidney disease can affect 80% of cats over the age of 15. We're gonna start seeing that as early as eight to 10 years of age. So I know we talk about cats being seniors around 10. And it's important to know that earlier than that, we should probably start doing some of these senior tests to make sure everything's okay. Arthritis is going to show up in 90% of cats over the age of twelve. Lymphoma, which is a type of cancer, is going to affect about thirty percent of cats in their lifetime. So one third of cats are gonna get lymphoma in their lifetime as of right now. High thyroid disease or hyperthyroidism and hypertension or high blood pressure affect about 10% of cats overall, which that number goes up for hypertension to 30% of cats over the age of 12. Okay. Weight loss is never normal aging in cats. I want you to make sure that we are always bringing that up with our pet parents. What would give you a plus plus plus? In my book is if you go get a baby scale and you keep it in your house. If you have a regular scale, great, put it beside it. And you weigh your cat once a month. And I want to know if they're changing. Okay. So when we're talking about testing, we want to make sure the very first thing that happens when you go in for your veterinary visit is that we touch on their muscle condition score and their body condition score. Most vets already do a body condition score. So that is essentially looking at are we an ideal body condition? Are we an ideal weight proportionally to our body? So with that, typically they're graded on a scale of one to nine. Anywhere from four to five is normal. And then, you know, one to three is underweight. Six to nine tends to be overweight pets. That's basically talking about. How easily can we feel the ribs by palpation without having to push too hard? How much excess fat do they have along their body? Things like that. Most cats should live in the 10 to 12 pound range. Small cats may be a little bit less, you know, our bigger cats or bigger cat breeds maybe a little bit more, but really we should not have 15 pound cats all the time. That's not typically normal. And most of the time our cats shouldn't be six pounds. They should typically be a little bit more than that. So unless they're smaller cats, some are. And then our muscle condition score, this one to me is almost as if not more important. We do know that overweight pets have a shortened lifespan. And we also know that pets that have muscle wasting have a shortened lifespan. So these two things are extremely important when we're talking about a lifespan of our pets. So with that muscle condition scoring, we're looking for a normal, mild, moderate, or severe amount of muscle condition and loss. And we do know that that is directly correlated to frailty and that frailty is directly correlated to a shorter lifespan in cats. So it's really important to make sure that we are on top of muscle loss because there are things we can do about it. There truly are. It's not something that We just have to deal with being able to see their hips more prominently or watching their back legs kind of shrink or seeing their shoulder blades more prominently. We can combat this. I have done it so many times in patients. We are bringing them back from muscle wasting using different modalities. There's so much we can do to help them. And we don't just have to accept muscle wasting. That being said, I want you to ask your vet. Please don't be afraid to do this. Write these things down. Okay. When you go in, say, hey, I want to know. Tell me the truth. Tell me what their body condition score is and tell me what the muscle condition score is. I want to know if they're overweight or underweight. I want to know if they have muscle wasting. And I want to know how we can help that because I want to keep Callie around as long as I possibly can. So I want to talk about it. We also know things like muscle loss and weight loss can show up. before we actually see signs on things like blood work for chronic kidney disease, thyroid disease, and cancers. So these can be early warning signs that we need to do some deeper testing, right? And also we can start to talk about nutrition. Are they on the right diet? Do we need to change these things? Whatever that may be. Now, from an Eastern standpoint, we are gonna say that some of that muscle atrophy could lead us to questions about Qi or blood deficiency, which is again part of why we use a lot of that food therapy and that targeted protein strategies to try and help these guys. We don't want to over restrict protein to early in cats. I think there has been some missed data in cats that don't have kidney dysfunction that are already being put on a restricted diet of protein and that's not appropriate. It can be appropriate to look at their phosphorus levels and make sure those aren't too high, but we want to make sure that we're not restricting their protein too much because this could lead to muscle loss, which leads to a decreased lifespan. No, no, that's not what we want, right? So I want you to also bring questions to these vet visits. Hey, she seems more lethargic. She's been going to the litter box a little bit more over the past couple of months. I'm worried about her muscle loss. Can we talk about these changes and what you recommend as far as further testing or ways to work this up? There are a lot of misconceptions when it comes to things like blood work, being able to catch diseases that it can't catch and x-rays and things like that. So we'll cover that a little bit more as well. But I think it's important for people to know that. We need to have the conversation about what tests are important. And if you can do every single test, hoo rah. I love that. That makes me so happy. But a lot of times we have to kind of pick and choose at each appointment. So we're going to be able to talk through those things and decide what's most important for that pet that's in front of us, right? So now we're going to talk about the blood work component of things. CBC. Is known as a complete blood count. So when we talk about basic blood work in cats, we're typically going to be getting a C B C chemistry, and potentially a urine sample along with that. So the CBC itself is going to check for our white blood cells. Are we seeing any signs of infection or inflammation? Our red blood cells, are we seeing signs of an anemia? And our platelets? Are we having any issues with clotting disorders? It's important to know blood work. Indicators. So the normals on the blood work machine are set to adult cats. They are not set to senior cats and they are not set to young cats. So when we have cats under the age of one and cats over the age of 10, we do have to know there are some variations in blood work that can be normal and it will show up as a red flag on our blood work. Example of that would be anemia can be something that happens with older cats, and it can be something we call anemia of chronic disease. Could be from things like kidney disease, but it can also just be from like chronic inflammation from arthritis or things like that. Typically, senior cats also have a lower white blood cell count overall. That is a normal finding, but it's gonna show up as a red flag on our blood machine. So these things are important to know. So that we don't freak out about them, right? Chemistry panel. So this is tracking our organ function. So we're looking at our pancreas, our liver, our glucose levels, our electrolytes, our kidney values. I had a patient who came in to see me. He was this beautiful ticker, I think. He was an orange male cat. Love an orange cat. They're just so cool. He came in to me for routine blood work and We did blood work on Tigger and it looked great. Everything was beautiful, right? And a month later he came in and his mom was like, look, he's throwing up and he looks like he's losing weight and he's drinking a lot of water. So we rechecked blood work on him one month later and his glucose had gone from normal, which is somewhere around 120, to 500, making him a diabetic just that quick. So it's always important to know. These values are a snapshot in time. Just because your pet had blood work six months ago and they weren't having any clinical signs doesn't mean that the blood work is now going to be not important just because we did it six months ago when now they're having new signs and symptoms associated with that, right? That's a very important thing that we should keep in mind when we talk about all of these parameters, because these are getting us a value in a moment of time. So The next thing that we're gonna look at is our urine sample. So I always urge people to talk about potentially bringing a urine sample with you and figuring out a way to do that or asking, making sure we're asking for a urine sample when you go in for your vet visits, right? So the reason for this is our chemistry values may tell us that there is an elevation in our kidney enzymes. So our chemistry panel may tell us, hey, your kidney enzymes are elevated on this cat. And those kidney values being elevated, they're kind of tricky because they can actually be from the kidneys having dysfunction to them, or it can be what we call pre- or post. So pre meaning before the kidneys, pre-renal or post-renal, meaning after the kidneys. So the way that we differentiate that, whether is it just dehydration or is it something that's happening in the liver that's causing this damage or something else, like a UTI or something causing this, we need a urine sample to evaluate how well the kidneys are concentrating urine, as well as checking for other things like sugar spillover or protein or crystal formation or anything like that. So it's important for us to also get a urine sample so that we can look for all of these things and get really a full picture for our blood work. The blood work is not complete on a senior cat without a urine sample, period. Okay. The next thing I wish I could stick a sticky note on every single door of every single veterinary clinic for this. It is so important and it is never done almost. Blood pressure. We need to check their blood pressure. 30% Of cats over the age of 12 are going to develop high blood pressure or hypertension. This can cause so many issues. It can cause a worsening of kidney disease. It can cause a worsening of thyroid disease. It can cause heart disease. It can cause blindness. Essentially, it causes their retinas or the the thing that they helps them see to detach. It can cause headaches. It's just generally uncomfortable to them. And a blood pressure check is very simple. It is a little tricky with cats. The actual test is very easy, takes five minutes. But we do have to place a little gelled up piece of a cord onto a cat's paw or tail. And they tend to not like that. And they have to sit still while the blood pressure cuff inflates and deflates, right? Just like you would think my Toddler did not like getting it done because it feels funny, but we can't explain to our cats why it feels funny, right? And we also know that our cats get really stressed out when they go to the vet frequently. And, or they get stressed out by being in the car, or they get stressed out by being in the carrier. So it's important to be prepared for our veterinary visits about blood pressure. I want you to call ahead and say, hey. I really want to get Callie's blood pressure when we're at her appointment. She gets a little stressed out in the car. Do you think that we should maybe give her some meds? Can I come pick up some medicine to give her beforehand? Or is there anything over the counter that I can do, like a pheromone diffuser or like getting her prepared so that she's not stressed out about her carrier? So bringing it out a couple days ahead of time, feeding them in it, you know, spraying feel away around it, giving them their favorite. treats inside of it or something? Is there some way that we can help do this where we feel like we're going to get an accurate reading? Is it helpful if I'm holding her or if I'm involved in the process? Is it better if we do it right when I get there or after everything? Should we do it while she's still in her carrier in the quiet room and cut the lights off, maybe? There's so many different ways we can come together for our senior cats and really give them the best opportunities at the vet clinic. And I just think we're doing them a disservice sometimes by the way that we handle certain parts of their care. And one of those is blood pressure. We really need to make sure that we're tracking this. It's very important. Another test is the thyroid test. So cats typically become hyper thyroid, which can lead to Muscle wasting can lead to heart disease, can lead to blood pressure issues, can lead to kidney issues, a lot of different modalities makes them lose weight very significantly and eat ravenously, are the two most common signs with that. So we want to make sure that we're checking those values as well. Sometimes we need to check a full thyroid panel as opposed to just a T4, but it's important for us to have those values because again, the earlier that we catch this. The more chance we have of being able to treat it without damaging the other organs. And thyroid disease is completely treatable. I have thyroid disease. I have low thyroid disease. And I take a pill every day for the rest of my life and here I am. So it is not a complicated treatment protocol, but it can get complicated if they have something called a thyroid storm where they come in and their their thyroid level is so high that it is causing multi organ failure. So it is something that I recommend keeping an eye on at least once a year. SDMA, this one is kind of one of our heroes for cats recently. It is something that checks kidney values early. So we have our kidney values on our chemistry panel. Those guys, unfortunately, don't actually pick up damage to the kidneys until 75% of the kidney is damaged. Now that's a lot. of damage to have before we even catch kidney disease. So we're really far behind. This SDMA value, which is now commonly on a lot of senior wellness panels, is going to pick up those changes at 25% damage to the kidneys. So we're picking this up 50% faster, which is amazing. So if we see that value is elevated and we combine it with a urine sample to know the specific gravity, then we can start preemptively treating these guys For their kidney dysfunction with diet protocols or therapeutic things like that to help them. So this is extremely important as well. Another test that can be discussed is called a ProBMP. This is a blood test and it checks for damage to the muscles of the heart. So cats are funny in the way that they don't always have a murmur if they're going to have damage to their heart. So this Pro BMP is a way that we can check. For those types of things early, right? Again, this is something where we are going to have an investment. So be prepared for this initial stuff to cost $250 to $600, depending on your location here in the US. I'm not as familiar with prices in other countries. The next thing that I want to talk to you about is cancer screening, imaging, those types of things. These are not always things that we track for at every that visit. It's typically one that we're gonna talk about. So I always surprise people when I tell them blood work does not typically pick up cancer. It is often not going to be something that tells you if your past cancer, it could be completely normal. So When we're looking for cancers in cats, typically we're looking more along imaging, so x-rays of the body or ultrasound of the body to get us more of an idea of what's going on inside of the the organs themselves and make sure everything appears to be normal. So imaging our x-rays, these are like our two D snapshot. Ultrasound is more of that like 3D image. So we actually get to see inside of the liver and What's going on in there? It are there any changes? What does the gallbladder look like? What does the urinary bladder look like on the inside? The X-rays are more of just like a from the outside. Is it a normal size and shape? Okay. But I can't see anything else beyond that. The ultrasound is what's gonna tell us like what does the inside of it look like, right? Then we have CTN MRI. These are typically for like brain or spinal cord issues, so neurologic disease, things like that. Dentals, I always want to make sure that you guys are asking how their teeth are and if there's anything we should be worried about with their their teeth. Dental disease is directly correlated with chronic pain and it can be related to dementia as well and other organ damage. So I want make sure we're working that up appropriately. So subtle things that we want to make sure we're checking on here would be appetite. Are they waking up at the middle of the night to eat? Are they ravenous about their food? Are they vomiting? What's happening there? Their litter box habits? Are we going more often? Are we noticing pee in different places? Accents autos of the box. Water intake. Are we drinking more? Are we asking for water more? Are we drinking less? Are we vomiting more? Those types of things. Grooming activities. Are we grooming less? Grooming more? Do we have more deandrophy or greasy skin or anything along those lines? And then their activity levels. So are we less active than we used to be? Or are we hiding more any of those symptoms that you're noticing? So I want you to go into these veterinary visits with this concept in mind. I want to know my cat's body condition score. I want to know their muscle condition score. I want to talk about routine testing. I want to talk about a blood pressure. And I want to have all of my questions written down on a sheet of paper so I can ask. And I want to make sure that we get to the bottom of all my questions and we talk about what options we can pursue to help us better understand what's going on with them. And I want you to make sure that you are advocating for your pet. I don't want you to see yourself as being a helicopter parent or as being extra or too much or anything like that. I want you to see yourself as my cat cannot talk for themselves. So I am here to advocate for them. I am here to tell you what I have seen at home that you're not gonna see here in the clinic because she's gonna crouch up in a corner and not move. I want you to tell your vet what you're noticing at home because I want your pet to have the best lifespan and health span that they can. And that can only happen by you speaking up. So don't see it as you inconveniencing anybody or like, being complicated or being too much or anything like that. You're being exactly what you need to be for your pet and to get them the help they need. I trust my senior pet parents so much when it comes to their senior cats. If they tell me, I know this stuff looks normal, but something is wrong, you best believe we are going to figure out what it is. I don't know how. I don't know how long it's going to take. I don't know how much it's going to cost. But I'll keep you up to date on that. But we're gonna go through all these different options until we figure it out. Because I a hundred percent believe in your intuition. I believe in how well you know your pet. And I believe that if you think something is going on, I think something is going on and we're gonna find it. Okay. Have you ever left the vet with more questions than answers? And then you drive home and you go straight on to Google. Yeah, I hear that a lot. And honestly, it's exactly why I created my senior pet virtual consultations. Imagine we have 45 minutes where we go through everything, your pet's full history, their specific challenges, their daily life, no rushing. We're gonna cover nutrition, integrative options, whole modifications, and quality of life. And I send you a personalized plan after so that nothing slips through the cracks here. But don't just take my word for it. Chelsea called it a senior pup therapy session and said she felt so much better afterwards. Adiba got recommendations her own vet had never thought to suggest, and Denise said that the consult was incredibly informative and helpful, giving her many options to help her dog Loki feel better. This is the conversation that your senior pet deserves. And honestly, The one you deserve too. The link is in the description. I'd love to help you. All right. With an integrative visit or an Eastern medicine visit, just so you all know, there's a little bit of a different pathway that goes down. We're gonna go with more of just like a physical exam. We check the color of the tongue. Is there any sort of a layer on the tongue, coloration to it? Is there spotting on the sides or the back or anything weird like that? Is it like fat or is it thin? We check for different things like damp and heat, and there's certain organs that are associated with certain parts of the tongue. So we're checking for all of that. We're checking the skin. There are certain things along the skin that are associated with certain organs in Chinese medicine. We are checking a good, like, hands-on exam to see are there any trigger points that are activated? Is the spleen trigger point activated? Is there anything else we're noticing? And we're also evaluating like their demeanor in the room, their eyes. We're evaluating any sources of heat that we can feel. We're checking for any signs of wasting, which is like a B syndrome or Way syndrome in pets. So we do have our own version of an exam in Chinese medicine. There's not as much of like the diagnostic component of some things. One of my favorite quotes from one of my integrative practitioners when I was going through Acupuncture training was if the ancient Chinese had access to blood work and imaging and MRI, don't you think they would have used it? Like, we don't need to fight one medicine with the other because the ancient Chinese would have used all the modalities if they could. Actually, in China, there is an integration of using things like acupuncture alongside like surgeries and things like that. It's really interesting. So my approach is both. I listen to the hard lungs. I do a western exam feeling all the joints for crepatus, things like that, give a muscle condition, a body condition score, and then also do my eastern exam where we're evaluating for all those trigger points and the tongue and the eyes and the heat sources and and all those types of modalities. So all right. You are doing such a good job. I am so excited about all the information that you got today. This is so cool. You are gonna go into your senior cat's appointment and you're gonna look like a veterinary student. You're gonna go in and you're gonna be like, I wanna know muscle condition score, body condition score. I wanna know what tests we're running. You talk to me about a C B C and a chemistry, you're gonna start saying all these words. Your veterinarian's gonna look at you and go, Are you in healthcare? And you're gonna be like, no, I just listened to senior pet talk and I'm really smart. And she taught me all this. So I'm super proud of you. This is my ultimate goal is to make you advocates and understand how to help your senior cats. So you are doing a beautiful job. I appreciate you being here and taking the time to talk with me. And if you have any questions, please feel free to reach out. Otherwise, you Have a beautiful day and hug that senior kitty for me, okay? That's it for today. If this episode helped you, please leave a review or rate this podcast so we can get the word out to more pet parents who need to hear that they are doing a good job. And if you're interested in working more with me, you can find me on social media or at senior petconnection.com because we all need to stay connected. Remember that you are doing a great job with the information that you have in this moment. And I am just here to give you more of it. See you next week.