Geriatric Cat Care
Dr. Douglas Brum
Many of these tests are recommended on geriatric cats even when they are feeling totally normal. The routine geriatric exam and accompanying diagnostic tests are recommended to ensure that the early stages of disease is discovered, and appropriate preventive measures and treatment plans instituted. A complete medical history. Any problems or concerns that you have about your pet should be discussed; however, it is equally important that the veterinarian ask specific questions that may uncover problems unknown to you. Certain problems that you may simply attribute to old age, and just something that they will have to live with, may be signs of underlying disease and be very treatable. Some veterinarians have specific geriatric health history questionnaires that can be filled out by the owner or a health professional. Asking the right questions is very important in obtaining a thorough geriatric health history.
The most common diagnostic tests performed by your veterinarian as part of a complete geriatric work-up include:
A complete physical examination. Your veterinarian will perform a complete physical examination that may uncover specific problems, including an eye and retinal exam. He or she will also check the ears for signs of infection or allergies; evaluate the mouth, gums and teeth for dental disease and gingivitis; palpate the lymph nodes and the thyroid gland for enlargement; observe the skin and quality of the hair coat, noting skin tumors or swellings; listen to the heart and lungs, noting the presence of new heart murmurs; palpate the abdomen for any masses or organ enlargements; and record the general body condition and weight.
Complete Blood Count (CBC). A CBC evaluates the red and white blood cell lines. A decrease in the red cells indicates anemia, not an uncommon finding in the geriatric animal. Red blood cell morphology (shape) is also assessed, and helps determine if the condition is acute, chronic or related to a neoplastic (cancer) condition. Increases in the total white blood cell count may indicate inflammatory or infectious conditions. The specific types of white cells (neutrophils, lymphocytes, eosinophils, monocytes and basophils) are also counted and are recorded in their relative proportions. Increases or decreases in individual white cell types may provide insight into various disease conditions. Occasionally, the presence of abnormal or immature white blood cells suggest a potential cancerous process.
Biochemical profile. The biochemical profile is a very valuable test in the geriatric animal as it evaluates multiple organ systems. The liver and kidney function are evaluated, and the blood sugar is checked. Elevations in the blood sugar may indicate diabetes, although, high blood sugars are commonly seen in cats that are just stressed due to the veterinary visit alone or other illnesses. Electrolytes are also checked and abnormalities may indicate the need for further diagnostics. Plasma protein and albumin level are also reported, and decreases might indicate kidney, liver or gastrointestinal disease.
Thyroid testing. Increased production of thyroid hormone by an overactive thyroid gland (hyperthyroid) is a very common problem in older cats. The most common signs of hyperthyroidism are increased appetite and weight loss.
Urinalysis. A sterile urine sample is obtained by inserting a needle through the skin into the bladder (cystocentesis) by the veterinarian. The urine sample helps in diagnosing kidney problems, bladder infections or diabetes. If indicated either by clinical signs or by the microscopic evaluation of the urine, the urine is cultured for bacteria.
Fecal examination for parasites. Since gastrointestinal parasites may be more debilitating in geriatric animals, a yearly fecal exam is recommended. Additionally, some parasites have zoonotic (spread to people) potential, re-enforcing the value of yearly fecal exams. Routine fecal floatation, and specific tests for Giardia are recommended.
FIV and FELV testing. Both of these viral diseases may cause suppression of the immune system and contribute to many other systemic illnesses. In cats that are at risk of exposure to these viral diseases (i.e. outdoor cats or cats that have contact with other cats) routine blood testing is recommended. If the viral status of a cat is unknown, testing is also advised.
The above represents the most routine diagnostic tests that your veterinarian may advise for your senior pet. Based on the history and physical examination findings, common additional testing might include:
Blood pressure measurement. Hypertension, or high blood pressure, is being increasingly identified in the geriatric cat. In fact, some veterinarians include the test as part of the geriatric cat's initial diagnostic work-up. Usually, hypertension is associated with other disease conditions such as kidney disease and hyperthyroidism. Ideally, the blood pressure should be measured before other diagnostic testing, since stress and excitement may falsely elevate the measurement.
Aspiration of skin masses. Small masses or lumps are commonly found on or under the skin. Many times these are benign tumors or cysts that grow slowly and rarely cause problems. However, cats do have a higher incidence of malignant skin tumors than do dogs. Because of this, it is usually recommended that all skin tumors on cats be aspirated and the recovered cells evaluated microscopically for evidence of malignancy. Sometimes the number or location of the masses makes sampling impractical. In these cases, your veterinarian can help determine if aspiration is worthwhile. The size and location of all masses should be recorded in the medical record, so that changes in previous masses or the development of new masses can be noted.
Radiographs. X-rays may be advised based on the initial tests or physical exam findings. Chest X-rays are part of a heart work-up. They are also needed for evaluating the lungs and as a screening test for cancer. Abdominal radiographs might be needed if organ dysfunction is suspected or organ enlargement or masses are palpated.
Cardiac evaluation. If there is indication of potential heart disease (i.e. a newly discovered or a worsening murmur) a more complete cardiac evaluation is indicated. Chest radiographs, an EKG and an echocardiogram will help better define the extent and cause of potential cardiac disease and whether treatment is necessary.
Abdominal ultrasound. Abdominal ultrasounds offer a non-invasive method of visualizing masses and organs within the abdomen. Generally, more detail and structure can be obtained with an ultrasound than with radiographs.
Endoscopy. Evaluating the stomach and initial part of the small intestines through the use of endoscopy is a valuable diagnostic tool. A common problem that some older cats have is a bowel disorder called inflammatory bowel disease (IBD). Cats with IBD usually have vomiting or diarrhea as symptoms, but sometimes present with weight loss as the only complaint. Endoscopy offers a relatively non-invasive method of obtaining gastrointestinal biopsies for establishing a diagnosis.
At the end of the geriatric visit, a geriatric wellness assessment may be completed and given to the owner.