Fear in cats is not commonly recognised in the veterinary practice. However, schemes such as the 'Cat Friendly Practice Awards' run by the Feline Advisory Bureau are helping to raise awareness about this important problem and most importantly looking at ways in which we can reduce stress and fear in our feline patients. Reducing fear for cats in a veterinary practice will not only improve the cats well being, it will also reduce the number of injuries sustained by members of staff due to fear-associated aggression.

Fear is a normal emotional response to consciously recognised external sources of danger. For cats this may start when seeing the cat basket being assembled for that 'dreaded trip to the vets'. Reducing the fear associated with this sort of stimulus is far easier to prevent than to treat. It is our job as members of the veterinary profession to educate our clients from as earlier a stage as possible, ideally even before the cat has been obtained. Simple steps can be taken in this instance by keeping the basket assembled and out in the house at all times to prevent this becoming a negative association with a trip to the vets. A cat carrier can be made into a fun hidey den for cats where treats are given to build up a positive association. Transporting a cat in a carrier should also be introduced gradually with lots of treats being given as positive reinforcement. Once the cat is at ease being in the carrier, small steps can be taken by initially moving the cat in the carrier, being placed in the car with the engine off then being in the car with the engine running. Finally journeys should be short in duration to begin with then gradually increasing as necessary. This gradual introduction can be more difficult with owners who use public transport. Additional advice can also be given as to the type of cat carrier that should be used. Some cats, for example a cat being transported on a bus, may prefer being in a covered over basket to reduce visual stress whilst others may find this very stressful and prefer to see out of their carrier. Carriers can also be pre-sprayed with pheromone spray to help reduce anxiety.

The veterinary practice can also do a huge amount to reduce fear in cats. When thinking how to be cat friendly it can be useful to break the practice down into different areas to think about how you can make that part of the practice less stressful for cats.

Waiting Room

The smell and the sound of dogs can cause a huge amount of stress to a cat, especially cats that are not used to dogs. A cat-only waiting room is the obvious solution; however, unless your practice is a feline-only practice, this can be hard to achieve. Thought should still be given as to where the cats are going to wait. Creating a cat-only waiting area where dogs cannot walk through and sniff around the cat's basket is very useful. If this is not achievable then ledges can be made for owners to put baskets out of the reach of dogs, a polite notice for dog owners to ensure their dog does not approach any cats in carriers or a container of towels labelled for cat owners to cover their carriers if they wish can all prove very useful in reducing fear and stress. If consulting rooms are available then nervous cats should be allowed to wait in there. Having cat-only appointment times is another option, and is well received by many cat owners and their cats.

Consulting Rooms

Cats will feel less threatened if they are allowed to walk out of their carrier rather than being dragged out. Consulting rooms should be secure for this to be allowed. Cat baskets can be placed on the floor with the door open while a history is being taken. This will encourage the cat to walk out of its own accord. Cats that are not keen to walk out and have a carrier in which the top can be removed should be taken out gently in this way. Certain cats may benefit from the person who examines them wearing a non-white tunic, to prevent white coat anxiety.

Hospitalisation

Hospitalisation can often be a very stressful experience for a cat. Away from home, being examined, medicated and the strong smells of the clinic are hugely stressful. It's not surprising therefore for cats to be fearful. Cats that are fearful show very similar signs to those that are in pain (see Figure 1) making pain assessment more difficult. Therefore, if we can reduce fear in the cat, assessment for pain will be easier and more accurate. Whilst we cannot eliminate fear in cats there are many things that the practice can do to make hospitalisation less frightening, which will in turn promote quicker recovery as well as making it easier for members of staff to treat the patient.

Figure 1. Signs of fear and pain in cats.

A cat-only ward is usually ideal in providing peace away from barking dogs and the reduction in the smell of canine pheromones. However, in a busy ward some cats may get very stressed by the smell of other cats, and if normally housed with a dog, they may in fact prefer to be hospitalised in a dog ward! Mixed wards can work well if cats are hospitalised away from dogs and cages are not too low for passing animals to stare into and not too high to prevent easy access to the cat. Kennels should be in a single line rather than facing each other to prevent eye contact.

Kennel design should also be considered. Plastic cages are preferable to the stainless steel variety, which can be cold and noisy. Some cats may also be scared of their own reflection in stainless steel cages and so newspaper may need to be taped to the inside of the cage to prevent this. Kennel liners or newspaper can be put down to reduce the cold and prevent the cat from slipping. All cats should be given a vet bed or a blanket and a bed to hide in or under to allow the cat somewhere to 'escape' from the noise and activities in the practice.

When admitting a cat for hospitalisation it can be very useful to take the time to find out the cat's basic preferences, e.g., are they an indoor/outdoor cat, where do they toilet, what do they eat, do they eat from bowls/saucers, what bedding do they prefer. From this information you can already reduce the stress by adapting the hospitalisation kennel as much as possible to the needs of the cat. Outdoor cats may prefer soil put into their litter trays or even a branch, if the cage allows, put into the cage to encourage exploration and scratching. Indoor cats may have a favorite bed or prefer a certain type of cat litter. Whilst it can sometimes seem a hassle, owners should be encouraged to bring something in from home to provide a familiar scent. It can be useful to have a selection of hidey beds. Igloos can, however, be difficult to wash effectively and so cardboard boxes may be more cost effective. Bowls for cats should be wide and shallow to avoid their whiskers touching the sides. Different bowls should be tried if a cat is not eating. Some cats prefer to eat from plastic bowls or ceramic saucers. Cats will often take the food out of a bowl and place it on the ground before eating; therefore, it can be worth doing this for an anorexic cat as they will sometimes eat the food from their bed but not from a bowl.

Anorexic Cats

Fear will commonly cause cats to become anorexic. Anorexic cats can be tempted to eat in many ways. Cats should be offered different smelly foods that are warmed to increase the aroma and palatability. Food should only be left in with the cat for a short amount of time and many different foods should not be offered all at once as this may cause an aversion to food, particularly with cats who are in pain or nauseous. Syringe feeding may also cause this. As well as this method being stressful for the cat it is also dangerous as the cat may aspirate the food. Hand feeding works very well, especially when the cat is being stroked or groomed at the same time. Sometimes all that is needed is to shake the bowl to remind the cat that food is there for eating or just sitting with the cat while he/she eats. Other cats prefer to eat in private so they should either have the front of their cage covered or be taken to a quiet private room to allow them some time out from the ward. Cats should not be tempted with human soups or baby food as they contain onion powder, which is toxic to cats and will cause anaemia.

Pheromones

Cat pheromone diffusers are effective in reducing stress in cats. Therefore, using these around the practice can help to calm a nervous cat. The use of the F4 fraction of the feline facial pheromone on your hands before examining the cat may also help.