FELINE-Feline Senior Health Care

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Small Animal/Exotics 20TH ANNIVERSARY Compendium July 1999

PANEL REPORT ON

FELINE SENIOR HEALTH CARE

PAIN MANAGEMENTRecognizing pain in cats may be difficult, but it should be assumed that they

experience pain under the same circumstances humans do. Acute pain may arise from disease processes, such as pancreatitis, gastrointestinal disease, feline lower urinary tract disease, and neoplasia; trauma; or surgery. Chronic pain is often associated with musculoskeletal disease, neoplasia, or chronic dental disease. Pain

produces undesirable physiologic responses that impair wound healing and recovery and is associated with an increased rate of morbidity and mortality. Careful consideration of the patients physical condition (including renal, hepatic, and cardiopulmonary function) will aid in the selection of a proper pain control modality and help avoid adverse consequences.

gesic potency is approximately fourto seven times that of morphine.Butorphanol has a ceiling above

which increasing dosage offers noadditional analgesia. Butorphanolcan provide visceral analgesia for ap-proximately 5 hours and somaticanalgesia for 1 to 1.5 hours. Admin-istration of butorphanol before sur-gery has been recommended. Bupre-norphine, a popular analgesic inEurope, is a agonist with a poten-cy approximately 30 times that of morphine. Its longer duration of ac-tivity makes buprenorphine usefulfor postsurgical analgesia.

Oxymorphone is a narcotic ago-nist with a potency approximately 10 times that of morphine. Seniorpatients and those with liver diseaserequire lower doses. Higher dosesmay produce behavioral changes.Oxymorphone may produce respira-

tory or central nervous system de-pression.

Fentanyl, as delivered by transder-mal patch, has been widely used infeline medicine. Fentanyl is ab-sorbed from the topically appliedpatch and reaches peak levels within3 to 6 hours. The drug is deliveredover approximately 3 to 5 days, butits analgesic effect may persist forsome time after patch removal. Fen-tanyl absorption is temperature de-pendent, and thus patients should beplaced on a warm-water circulating blan-ket or other heat source to avoidheating the patch directly. Patchescan be subsequently applied for con-tinued analgesia. To prevent substanceabuse in humans, it is recommendedthat patients return to the hospitalfor removal and disposal of the patch.

Other than aspirin, nonsteroidalantiinflammatory drugs (NSAIDs)have not been widely used in felinemedicine in the United States. Two

NSAIDscarprofen and keto-profenhave recent-ly been used in Eu-rope and Canada forshort-term manage-ment of pain in cats. Adverse reactions, in-

cluding renal failureand bleeding, have

been reported. As with most of the

other analgesicsdiscussed, nei-

ther of thesedrugs is cur-

rently ap-proved foruse in cats

in the UnitedStates.

Control of Acute PainPrevention of acute pain is impor-

tant in reestablishing metabolichomeostasis. Unless contraindicatedby the patients condition, pain con-trol should be initiated as soon aspossible after the initial patient eval-uation.

Opioid analgesics, the mainstay of short-term pain management incats, are easily administered, havepredictable actions, can be chemical-ly reversed, and result in compara-tively few side effects. However, any patient receiving an opioid shouldbe monitored, with attention givento cardiac and respiratory functions.

Butorphanol is an opioid ago-nist/antagonist that is agonistic atthe and sites and antagonistic atthe receptors. Butorphanol willantagonize agonists, such as oxy-morphone and fentanyl. Its anal-

Editor s Note: This is Part II of a condensed version of thePanel Report on Feline Senior Care presented by the American Associa-tion of Feline Practitioners (AAFP) and Academy of Feline Medicine (AFM). Part I of this presentation, which included a com-plete list of the panelists and reviewers as well as a bibliography, appeared in the June (Vol. 21, No. 6) 1999 issue of Compendium .The entire document is available from the AAFP; call 800-204-3514 for copies.


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Control of Chronic PainRecognition of chronic pain may

be difficult in many senior cats be-cause of the insidious nature of itsonset. Cats may be reluctant to move

and jump or may be increasingly ir-ritable, reclusive, or aggressive towardowners and other animals. Changesin eating or elimination habits, in-cluding inappropriate elimination,may be a result of chronic pain.Owners often attribute these behav-iors to just getting old, so carefulquestioning is often necessary toavoid misinterpretation.

Management of chronic paincaused by osteoarthritis is difficult.

Corticosteroids have been the main-stay of osteoarthritis management,but their long-term use producesside effects, especially in cats withpreexisting renal, hepatic, or othersystemic disease. Corticosteroids canalso cause additional musculoskele-tal problems. However, cats are moreresistant to these complications thanare other species.

Nonsteroidal antiinflammatory drugs have been used with some

success to alleviate arthritic pain incats. Aspirin is occasionally used,but the depth of its analgesic effectis believed to be insufficient for ef-fective pain management. NewerNSAIDs, such as carprofen and ke-toprofen, are used in Europe andCanada for analgesic purposes incats, but use of these drugs is con-troversial because their side effectscan be severe. They are generally re-served for acute exacerbations of

pain.Chondroprotective agents, such asglycosaminoglycans and chondroitinsulfate, purportedly resolve some os-teoarthritic changes by allowing forrepair of articular cartilage. Theseagents are available in injectable andoral preparations and produce seem-ingly few side effects. Combinationsof therapies are often used. For in-stance, osteoarthritic cats may betreated long-term with chondropro-

Compendium July 1999 20TH ANNIVERSARY Small Animal/Exotics

G U I D E L I N E S

tective agents, with the addition of other medications such as NSAIDs

when acute pain is recognized.Environmental modifications may

help make arthritic cats more com-

fortable. Carpeted ramps to favoriteperching areas, heated bedding, andowner-assisted grooming may behelpful. Older cats may be reluctantto climb stairs, so relocating litter-boxes in more accessible areas andreducing the height of litterbox rimsmay prevent inappropriate elimina-tion. Weight loss reduces the stresson compromised joints in overweightcats.

Alternative therapies should be ex-

plored for their potential role in thetreatment of chronic pain. Acupunc-ture, for example, has been shown toincrease brain endorphin levels andalleviate pain in humans, dogs, andhorses. It is evident that much moreresearch needs to be done on themanagement of chronic pain in cats.Sadly, research in the area of felinepain management is minimal, andagents with proven safety for long-term use do not exist. The develop-

ment of analgesic agents and furtherstudies in the management of painin cats are needed.

ANESTHESIAVeterinarians are often reluctant

to anesthetize senior patients, risk-ing incomplete diagnosis or inade-quate therapeutic care. Age alone isnot a reason to avoid anesthesia.Studies in humans relate a higher in-cidence of mortality in anesthetized

senior patients, but the higher ratesare associated with ongoing diseaseprocesses rather than with the anes-thesia itself.

Thorough patient evaluation isnecessary to minimize risks associat-ed with anesthetic induction, main-tenance, and recovery. Appropriateselection of preanesthetic and anes-thetic regimens and adjunctive pro-cedures is of primary importance.Complete physical examination and

aSee the Diagnostic Testing section inPart I of this presentation (June [Vol. 21.No. 6] 1999) for more information onappropriate tests to perform in senior cats

with and without clinical signs of disease.

minimum diagnostic testinga are es-sential, but electrocardiography, echo-cardiography, radiography, and bloodpressure determination as well as ad-ditional laboratory testing may be

necessary depending on physical ex-amination findings and/or initiallaboratory results. Correction of un-derlying abnormalities should beginpreoperatively when possible. Select-ing a regimen with which the veteri-narian is knowledgeable and com-fortable may be one of the mostimportant considerations.

To avoid catecholamine-inducedcardiac arrhythmias, gentle handlingis extremely important. Preoperative

medications generally include com-binations of tranquilizers, opioids,dissociatives, and benzodiazepines.Combinations permit lower dosagesof any single drug, thereby limitingside effects and allowing smootherinduction by whatever method ischosen. However, the choice of pre-operative medications should be de-termined by the patients condition.The most commonly used combina-tions include diazepam with keta-

mine, acepromazine with ketamine,acepromazine with ketamine and bu-torphanol, and tiletamine with zo-lazepam. Tiletamine with zolazepamgenerally produces longer anestheticduration and more pronounced car-diovascular effects than do ketaminecombinations.

Anticholinergic drugs should beused with caution, especially in cats

with heart rates exceeding 180 beats/min. Cardiovascular and respiratory

parameters, including blood pres-sure, warrant careful monitoring when using any of these drugs. Forall but the shortest procedures, iso-flurane is the maintenance agent of choice because it has the least effecton cardiovascular parameters.


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G U I D E L I N E S

Some anesthetic drugs must beused with extreme caution in oldercats because of negative effects onhomeostasis. For example, propofol,an injectable anesthetic used for

short-term procedures, must be giv-en slowly or it will induce apnea.Propofol can also cause arterial hy-potension and bradycardia. Becausepropofol is a phenolic compound, itcan cause Heinz-body anemia withrepeated use. Degradation relies onthe cytochrome P-450 system, so ef-fects may be prolonged because of low levels of this enzyme system.

All anesthetized senior cats shouldhave a cuffed endotracheal tube in

place to prevent aspiration and en-sure an open airway should assistedventilation become necessary. Whencats are maintained on inhalantagents, such as isoflurane, depth of anesthesia can be quickly adjustedbased on the procedure and the pa-tients reactions. An indwelling in-travenous catheter ensures vascularaccess and facilitates the fluid ad-ministration necessary to maintainadequate perfusion. Inadequate per-

fusion can result in impairment of renal function, delayed metabolismof drugs, or more serious complica-tions. However, excessive fluid ad-ministration may cause pulmonary hypertension, especially in patients

with cardiac or renal impairment.Estimates of blood pressure ob-tained by an indirect Doppler pro-vide an indication of whether perfu-sion pressure to vital organ systemsis adequate.

Additional techniques that may beemployed include continuous elec-trocardiography, respiratory monitor-ing, and pulse oximetry. Periodic de-termination of rectal temperature isrecommended because maintainingbody temperature, important in allsurgical patients, is critical in oldercats with decreased body fat. Placinganesthetized patients on heated ta-bles, warmed blankets, or circulatinghot-water pads can minimize heat loss

produced by reputable manufactur-ers, and have passed feeding trialsapproved by the Association of

American Feed Control Officials(AAFCO). Diet-related problems

may increase if unknown, untested,or homemade diets are fed. Ade-quate water intake should be en-couraged; if cats seem predisposedto dehydration, intake may be en-hanced by providing bottled or run-ning water from a tap or fountain.Some cats prefer their water fla-vored with small ice cubes madefrom chicken or fish broth in their

water bowls. Providing fresh waterin filled, wide-mouthed bowls may

facilitate drinking. It is also helpfulto place several bowls throughoutthe house in areas easily accessible tothe cat.

There is no evidence that specialsenior diets are necessary if the catis healthy and consumes a nutrition-ally balanced and complete adultmaintenance diet. However, mostcommercial diets are restricted inmagnesium content and are formu-lated to produce an acidic urine pH

in order to reduce the risk of stru-vite urolithiasis. Although the risk of struvite urolithiasis decreases in old-er cats, the incidence of oxalate uro-lithiasis increases, particularly in catsolder than 10 years of age. Becausecat foods formulated for the preven-tion of struvite crystals are believedby some to contribute to calcium ox-alate formation, diets that are notmagnesium restricted and maintaina more neutral urine pH may be more

appropriate for older cats.

during the anesthetic and postanes-thetic periods. Infant incubators offera convenient means of providing heatduring the postanesthetic periods.Because cats lose heat from their ex-

tremities, placing infant socks ontheir feet can also help reduce heatloss, as can wrapping the patient inbubble wrap or running the intra-venous line through a heating source.Monitoring should continue untilthe patient is able to maintain homeo-stasis without assistance.

NUTRITIONALCONSIDERATIONS

Nutritional needs change during

aging, but few studies have investi-gated the nutrient needs of cats dur-ing the last quarter to one third of their life span. Pending more infor-mation, only tentative recommenda-tions can be offered beyond soundgeneral advice based on diet history,physical examination, and appropri-ate diagnostic testing. The diet his-tory should be obtained from theperson who feeds the cat and shouldinclude the following information:

what the cat eats (in sufficient detailthat it could be purchased accurately [brand, form, flavor]); how much isconsumed in standard units (a cupmay mean an 8-oz measuring cup tothe clinician but a 12-oz drinkingcup to the client); the feeding sched-ule (ad libitum, meals, or somecombination of the two); treats,supplements, or any additional foodprovided; the quality of the cats ap-petite (ravenous, excellent, good,

fair, or poor); and recent changes inany of the above and the explana-tion if known. In addition to theusual parameters, the physical ex-amination should include body

weight and body condition score(BCS), feces, and coat quality.

Healthy Older CatsHealthy older cats should con-

sume diets with which the veterinar-ian has had positive experience, are


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tein-containing ingredients are theprimary source of dietary phos-phate, a possible benefit of proteinrestriction is dietary phosphorus re-duction. Dietary protein intake

should be sufficient to maintain a leanBCS of 3, a goal generally achievedby consuming at least 2 g/lb/day of high biological value protein.

Recommending restriction of nonessential dietary protein for pa-tients with uremia is based on thepremise that this will decrease theproduction of nitrogenous wastes,thereby ameliorating such associatedclinical signs as anorexia, vomiting,uremic ulcers, lethargy, and weight

loss. However, there is no proof thatsuch an effect occurs in cats or thatconsuming a restricted-protein dietslows the progression of renal dis-ease. As a result, there is currently no reason to restrict protein intakein cats with no clinical evidence of renal disease or in those with only mild azotemia. In fact, inadequateprotein intake can cause protein de-pletion and its consequences, evenin healthy cats.

Potassium depletion is commonin senior cats, especially those withrenal insufficiency. Potassium-re-plete, nonacidifying diets should befed to help control hypokalemia. Al-though oral potassium supplementa-tion of all cats with CRF has beenadvocated by some, there is notenough evidence to support such arecommendation. However, oralpotassium supplementation is rec-ommended when serum potassium

levels fall below 4 mEq/L. Eitherpotassium gluconate or potassiumcitrate can be used to correct hy-pokalemia and may correct or pre-vent such associated effects as hy-pokalemic myopathy, reduced renalfunction, and anorexia. Potassiumsupplements also provide an alkalin-izing effect and may limit progres-sive renal injury.

Metabolic acidosis is common incats with CRF and has been shown

sary, the enteral route is the pre-ferred approach. Because of theslower healing response of most can-cer patients, gastrostomy or jejunos-tomy tubes should not be removed

earlier than 2 weeks after placement,even if the patients ability to eat re-turns before that time. Provision of enhanced quantities of arginine,carotene, cystine, fiber, glutamine,omega-3 fatty acids, and/or taurinehas been recommended for felinecancer patients, but no validateddosages or supporting data are cur-rently available for these nutrients.

Diabetes Mellitus

The primary goals of nutritionalmanagement of older diabetic catsare similar to those for younger cats:to attain and maintain optimal body condition (a BCS of 3); to minimizepostprandial fluctuations in bloodglucose by feeding diets low in sim-ple sugars; and to match the diettype, quantity fed, and times of feeding with the effects of exoge-nously administered insulin or othertherapy. Food intake should be

monitored carefully in senior cats.The role of dietary fiber in the man-agement of diabetes mellitus re-mains controversial.

Other Diseases Older cats suffer from many dis-

eases that afflict younger cats. Insuch cases, diet and feeding recom-mendations for senior patients differmainly by the greater concern for ad-equate nutrient intake in the face of

decreased activity and appetite. Eventhough the relationship of diet to theformation and composition of uro-liths is complex and incompletely un-derstood, regardless of stone type,cats of all ages with a history of urolithiasis should be fed a high-moisture (canned food) diet and en-couraged to consume water. Becausedietary allergens are believed by some to play a role in the pathogene-sis of some cases of inflammatory

to contribute to the progression of this disease. Thus feeding urine-acid-ifying diets to patients with CRFshould be avoided. Most diets thatare designed for CRF patients are

nonacidifying and are beneficial inthis respect. These diets are often re-stricted in phosphorus as well, whichmight help limit progression of renaldisease and renal secondary hyper-parathyroidism, with its resultantsoft tissue mineralization and renalosteodystrophy.

Cardiovascular Disease Patients with congestive heart fail-

ure (CHF) may be obese or cachec-

tic, so energy requirements vary. Po-tassium depletion is a potentialproblem associated with the use of loop diuretics, such as furosemide,in patients with CHF. Magnesiumdeficiency may be more common incats with CHF than is generally rec-ognized because of the feeding of mag-nesium-restricted diets and magne-sium wasting induced by diuretics,digitalis, and aldosterone. The feed-ing of urine-acidifying, magnesium-

restricted diets to patients receivingdiuretics or digitalis or to patients with hypertension or hypokalemiashould be avoided. Hypertensivecats may benefit from sodium re-striction, but dietary change alone isfrequently insufficient to lowerblood pressure.

Hyperthyroidism Current nutritional recommenda-

tions for older cats with hyperthy-

roidism are limited to ensuring ade-quate caloric intake.

Neoplasia The food intake of cancer patients

should be monitored closely, andsupport should be provided before

weight loss occurs. Easily digested,highly palatable diets containing nu-trients with high bioavailability may help patients maintain nutrient re-serves. If invasive support is neces-


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bowel disease (IBD), dietary therapy may be helpful. Trial therapy with aneasily digested diet containing a nov-el protein and carbohydrate source isfrequently recommended. Incorpora-

tion of omega-3 fatty acids into thediet has been shown to have antiin-flammatory effects on the gastroin-testinal mucosa and may be of bene-fit to patients with IBD. As in themanagement of diabetes mellitus,the role of dietary fiber in the man-agement of IBD is unclear.

FEEDING CONSIDERATIONSOwners should monitor the daily

food intake of senior cats. A de-

crease in appetite is often an early sign of the worsening of a problemor the development of complica-tions. Owners of sick elderly catsmay encourage eating by offering fa-vorite foods; feeding from wide,shallow bowls; warming or moisten-ing the food; offering fresh food fre-quently and in a quiet environment;and petting the cat during feeding.Learned aversion (avoidance of afood because its presence has been

associated with an unpleasant expe-rience) can be induced in cats by of-fering novel foods, such as veteri-nary prescription diets, to sick,hospitalized cats. The risk of devel-oping a learned aversion can be mi-nimized by delaying introduction of a new diet until a sick cats condi-tion has improved. Patient healthshould not be compromised by of-fering only a therapeutic or prescrip-tion food specifically formulated to

accommodate the patients condi-tion. It is better for an ill cat to eatsomething than to eat nothing at all.

For patients taking medication,drugnutrient interactions may influ-ence dietary intake or nutritional re-quirements. A list of common interac-tions can be found on the Internet at

www.cahe.nmsu.edu/pubs/_e/e507.html.

Like all recommendations madeto clients concerning their cats, nu-

Although some gross lesions willbe visible during routine inspection,a thorough oral cavity examination

cannot be performed in mostcats without sedation or anes-

thesia (see Anesthesia section),especially if the mouth is pain-ful. The examination should

include careful inspectionof the lips, gingiva (in-cluding measurementof the depth of peri-

odontal pock-ets), teeth

(includingevaluationfor resorp-

tive lesions), allsurfaces of the tongue,the oropharynx, the nasopharynx,and the larynx.

Oral cavity radiographs are rec-ommended if significant periodontaldisease is identified or if retaineddental roots, resorptive lesions, bonelesions, or apical abscesses are sus-pected. In fact, radiographic evalua-tion is suggested if any oral lesionsare detected (e.g., neoplasia may be

misdiagnosed as gingivitis). The bestdetail is obtained with dental radio-graphic film, but standard high-de-tail radiographic film can be used.Standard radiograph machines canprovide good results with either filmtype if appropriate exposures andtechniques are used. However, den-tal radiograph units are more versa-tile, easier to use, and require mini-mal manipulation of the patient inthe production of high-quality den-

tal radiographs. It should be notedthat changes induced by the agingprocess are sometimes difficult todifferentiate radiographically fromearly or mild periodontal disease.

With normal aging, the density of supportive bone increases and thelamina dura is less discernible. Theindistinct lamina propria could bemisinterpreted as periodontal dis-ease. The increased bone density could be misconstrued as sclerosis or


G U I D E L I N E S

tritional recommendations requireconsideration of the individual pa-tient. Further, caution is ad-vised when attempting toextrapolate the results of

studies done on other spe-cies. It remains to be provenhow similar old rats, dogs,and people are to old cats.Keeping normal older catsin moderate body con-dition, feeding themsatisfactory diets,and encouragingphysical activity will go along way toward helping themreach their genetic life expectancy.

ORAL CAVITY DISEASEOral cavity disease is an of-

ten overlooked cause of significantmorbidity in older cats and can con-tribute to a general decline in atti-tude and overall health. Appropriatetreatment often leads to a markedimprovement in quality of life andactivity. However, the clinical signsof periodontitis, gingivitis, stomati-tis, dental disease, oral ulcers, or oral

cavity tumors may go unnoticed by some owners. Inappetence, weightloss, halitosis, chattering teeth, ab-normal chewing and/or swallowingbehavior, decreased grooming, ornasal discharge (usually unilateral)are common signs but may be un-observed or attributed to other caus-es. Infection often accompanies oralcavity disease and may result in in-termittent bacteremia or septicemia.This may in turn lead to disorders

in other body systems, including hy-perglobulinemia due to immunestimulation, immune-complex renaldisease, chronic interstitial nephritis,hepatitis, and possibly cardiovascu-lar disease. In addition to secondary diseases, oral disease can causechanges in diagnostic test results be-cause of hyperglobulinemia, reactivehepatopathy, and septicemia. Thesechanges should not delay anesthesiaand treatment of dental disease.


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G U I D E L I N E S

a response to chronic bone inflam-mation.

Following inspection and radio-graphic examination, biopsy samplesshould be obtained for cytologic and

histopathologic examination fromareas of abnormality, particularly if there is concern about the characterof the lesion and neoplasia is sus-pected. Treatment of existing dentaldisease, periodontitis, and gingivitisshould then proceed as necessary and appropriate. Routine use of an-timicrobials is controversial. Addi-tional medications may be pre-scribed depending on the physicalfindings and results of biopsies or

procedures. If an invasive, neoplasticlesion is identified, further evalua-tion and treatment should be pur-sued. A complete description of theresults of the oral cavity inspection,procedures performed, results of biopsies, and therapeutic recom-mendations should be recorded inthe patient record. This should in-clude a chart of the dentition; areasof disease, depth of periodontal sul-ci, and tooth loss should be clearly

identified. Because care of the oralcavity should be an ongoing process,maintaining good records is essentialin order to monitor changes anddocument improvement or diseaseprogression.

Owner participation in the oralhealth care program will improve re-sults and slow the progression of dis-ease in many cats. The client shouldbe given a clear description of theplan for future dental care, including

options for home care. The homecare program should fit the ownersexpectations, abilities, and lifestyle.Reevaluation schedules, diets, androutine dental prophylaxis visits for aparticular patient will vary depend-ing on these factors as well as any co-existing health problems.

PET LOSS, EUTHANASIA, ANDGRIEF MANAGEMENT

As veterinarians, one of our most

compassion and the process carriedout with respect and reverence, ide-ally in a private room. Euthanasia athome can be comforting to bothclient and pet and should be consid-

ered in select situations. It is impor-tant to discuss the options for careof the remains before euthanasia andto describe what may occur duringthe euthanasia process (e.g., failureof the eyes to close, protrusion of the tongue, muscle spasms, agonalrespirations, elimination).

The client should sign a euthana-sia consent form if at all possible. Incertain situations, such as during amedical emergency or surgery, an

immediate decision may be warrant-ed in the absence of the client. Inthese cases, it is appropriate to ob-tain telephone permission with athird-party witness and to docu-ment the information in the medicalrecord.

Preplacement of an intravenouscatheter and tranquilization prior toeuthanasia usually help minimizecomplications. Ausculting the thoraxafter giving the euthanasia injection

and pronouncing the cat dead helpsclients with closure. After the eu-thanasia, the client should be giventime alone with the cat if desired.

important roles is to understand andrespect the humananimal bondand the impact that pet loss canhave on our clients. Helping ownersprepare for the loss of an aged pet

and the grief that can occur is a valu-able and memorable service we canoffer. It can affect the pet ownersability to cope with the loss of abeloved pet and can make the differ-ence as to whether owners will everhave a pet again.

During euthanasia, there are sev-eral steps that can facilitate the pro-cess for clients. Clients should un-derstand that euthanasia is the act of causing death without pain. It is a

humane option for terminally illcats or for those with a poor quality of life that is unresolvable by medi-cal intervention. The veterinariansrole is to provide information andhelp the owner reach a decision; careshould be taken to not judge or con-demn. The decision ideally shouldinvolve the participation of the en-tire family. Advanced planning may help the family prepare for the even-tual loss of a beloved pet.

Client presence during euthanasiashould be permitted because it is of-ten beneficial to the grieving pro-cess. Clients should be treated with

s University of California-Davis: 916-752-4200s University of Florida: 352-392-4700; dial 1 then 4080s Michigan State University: 517-432-2696s Chicago Veterinary Medical Association: 630-603-3994s Virginia-Maryland Regional College of Veterinary Medicine:

540-231-8038s The Ohio State University: 614-292-1823; [email protected] Tufts University: 508-839-7966s Cornell University: 607-253-3932s Iowa State University: 888-478-7574; www.vetmed.iastate.edu/supports AVMA Pet Loss Page: www.avma.org/care4pets/avmaloss.htms Delta Society Pet Loss and Bereavement:

www.petsforum.com/deltasociety/dsn000.htm

Pet Loss Support Hotlines and Web Sites


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cess may be important becausemany owners are not aware thattheir grief may equal that associated

with the loss of a human loved one.However, emotional support from co-

workers and friends may be nonex-istent. Pet owners should be madeaware of written materials that dis-cuss pet loss, pet loss support groups


The body can be covered, or partial-ly covered, showing only the head.Some clients like to brush the cat,clip fur to save, or position the body,often with a favorite toy or blanket.

Clients and members of the vet-erinary team should not be afraid toexpress their own feelings of grief.Discussions about the grieving pro-

and hotlines, and other support op-tions (see Pet Loss Support Hotlinesand Web Sites). Within a few daysof pet loss, contacting the client by phone or sending a condolence card

or personal letter is encouraged.Clients may be comforted by a con-tribution made to a cat-related char-ity in their cats memory.

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FELINE-Feline Senior Health Care