CompendiumVet.com | Peer Reviewed | Listed in MEDLINE Vol 31(6) June 2009
3 CE Contact Hours CONTI N U I NG EDUCATION FOR VETERI NARIANS ®
Ve e ium
ar l Q
m O nd
m # om
Addi B h i S i
Adding Behavior Services
2009 Vol 31(6)
CompendiumVet.com | Peer Reviewed | Listed in MEDLINE
Anesthesia Internal Medicine
Nora S. Matthews, DVM, DACVA Dana G. Allen, DVM, MSc, DACVIM AMERICAN
Texas A&M University Ontario Veterinary College BOARD OF
Cardiology Internal Medicine and Emergency/ VETERINARY
Bruce Keene, DVM, MSc, DACVIM Critical Care PRACTITIONERS
North Carolina State University Alison R. Gaynor, DVM, DACVIM
(Internal Medicine), DACVECC
Clinical Chemistry, Hematology,
North Grafton, Massachusetts BOARD
Betsy Welles, DVM, PhD, DACVP Nephrology Kurt Blaicher, DVM, DABVP
Auburn University Catherine E. Langston, DVM, ACVIM (Canine/Feline)
Dentistry Animal Medical Center
Plainﬁeld Animal Hospital
Gary B. Beard, DVM, DAVDC New York, New York
Plainﬁeld, New Jersey
Auburn University Neurology Canine and Feline Medicine
EDITOR IN CHIEF R. Michael Peak, DVM, DAVDC Curtis W. Dewey, DVM, MS, DACVIM
The Pet Dentist—Tampa Bay Veterinary (Neurology), DACVS Eric Chafetz, DVM, DABVP
Douglass K. Macintire, Cornell University Hospital for Animals
DVM, MS, DACVIM, DACVECC
Largo, Florida Vienna Animal Hospital
Department of Clinical Sciences Emergency/Critical Care and Ann E. Hohenhaus, DVM, DACVIM Vienna, Virginia
College of Veterinary Medicine Respiratory Medicine (Oncology and Internal Medicine) Canine and Feline Medicine
Auburn University, AL 36849 Lesley King, MVB, MRCVS, DACVECC, Animal Medical Center
DACVIM New York, New York Henry E. Childers, DVM,
University of Pennsylvania DABVP (Canine/Feline)
Gregory K. Ogilvie, DVM, DACVIM
Endocrinology and Metabolic Disorders (Internal Medicine, Oncology), Cranston Animal Hospital
Marie E. Kerl, DVM, ACVIM, ACVECC DECVIM-CA (Oncology) Cranston, Rhode Island
University of Missouri-Columbia CVS Angel Care Cancer Center Canine and Feline Medicine
and Special Care Foundation
for Companion Animals
ADVISORY Philip H. Kass, DVM, MPVM, MS, PhD, Carlsbad, California
David E. Harling, DVM,
BOARD DACVPM DABVP (Canine/Feline),
University of California, Davis Ophthalmology DACVO
MEMBERS David A. Wilkie, DVM, MS, DACVO Reidsville Veterinary Hospital
The Ohio State University Reidsville, North Carolina
Behavior Canine and Feline Medicine,
Thomas N. Tully, Jr, DVM, MS, DABVP Parasitology
Sharon L. Crowell-Davis, (Avian), ECAMS Ophthalmology
Byron L. Blagburn, MS, PhD
DVM, PhD, DACVB Louisiana State University Auburn University
The University of Georgia Jeffrey Katuna, DVM, DABVP
Reptiles David S. Lindsay, PhD
Douglas R. Mader, MS, DVM, DABVP (DC)
Virginia Polytechnic Institute Hospital
Dermatology Marathon Veterinary Hospital and State University
Craig E. Grifﬁn, DVM, Marathon, Florida Natick, Massachusetts
DACVD Pharmacology Canine and Feline Medicine
Animal Dermatology Clinic Katrina L. Mealey, DVM, PhD, DACVIM,
Karen Rosenthal, DVM, MS, DABVP
DACVCP Robert J. Neunzig, DVM,
San Diego, California (Avian)
Washington State University
University of Pennsylvania DABVP (Canine/Feline)
Rehabilitation and Physical Therapy The Pet Hospital
Wayne S. Rosenkrantz, Feline Medicine Bessemer City, North Carolina
Darryl Millis, MS, DVM, DACVS
DVM, DACVD Michael R. Lappin, DVM, PhD,
University of Tennessee Canine and Feline Medicine
Animal Dermatology Clinic DACVIM (Internal Medicine)
Colorado State University
Tustin, California Surgery
Compendium is a
Margie Scherk, DVM, DABVP Philipp Mayhew, BVM&S, MRCVS,
(Feline Medicine) DACVS refereed journal. Articles
Cats Only Veterinary Clinic Columbia River Veterinary Specialists published herein have
Kathryn E. Michel, DVM, Vancouver, British Columbia Vancouver, Washington
MS, DACVN been reviewed by at least
University of Pennsylvania Gastroenterology C. Thomas Nelson, DVM two academic experts on
Debra L. Zoran, DVM, MS, PhD, Animal Medical Center
the respective topic and
DACVIM (Internal Medicine) Anniston, Alabama
Surgery Texas A&M University by an ABVP practitioner.
Elizabeth M. Hardie, Toxicology
Infectious Disease Tina Wismer, DVM, DABVT, DABT Any statements, claims, or product
DVM, PhD, DACVS Derek P. Burney, PhD, DVM ASPCA National Animal Poison Control endorsements made in Compendium
North Carolina State Gulf Coast Veterinary Specialists Center are solely the opinions of our authors
and advertisers and do not necessarily
University Houston, Texas Urbana, Illinois
reﬂect the views of the Publisher or
Coming Events Canadian News
Ontario Veterinary Medical Association:
Career Planning for Associate
Veterinarians & Potential Practice Owners
Canadian Government Invests in
Ontario Veterinary Medical Association
This course will present the beneﬁts and
Western College of Veterinary Medicine
downsides of owning a practice as well as
he government of Canada is invest- The construction of a two-story addi-
the practical aspects of practice ownership. ing $2.7 million in the infrastructure tion and basement will add 3000 m2 of
of the University of Saskatchewan’s additional space to the diagnostics facil-
August 8–13 Western College of Veterinary Medicine ity. Once completed, the centre will
World Association for the Advancement (WCVM). The funding, coming from the be a major western Canadian hub for
of Veterinary Parasitology: 22nd Canadian Western Economic Diversiﬁca- veterinary diagnostics services, ani-
Calgary, Alberta tion program, will be used on upgrades mal health research, and specialized
This conference will discuss current issues to the large animal clinic and the diag- training in diagnostic pathology, virol-
in parasitology. nostics laboratory at the college. ogy, bacteriology, immunology, and
Web waavp.org The upgraded facilities will make a range of biomedical sciences.
September 9 the college, province, and country “The expansion of the college’s
Calgary Academy of Veterinary more competitive, according to Minister diagnostics area and the renovation of
Medicine: Ophthalmology of State Lynne Yelich. “Investments our large animal clinical services will
Clara Christie Theatre, Health Sciences such as these will lead to new diag- provide our staff and students with
University of Calgary, Alberta
This seminar will offer 1.5 hours of scientiﬁc nostic tests that will protect Canada’s specialized, biosecure facilities where
CE and will be presented by Dr. Cheryl Cullen. livestock industry and the health and they’ll have access to a full range of
Phone 403-863-7160 safety of Canadians, their families, and new technologies,” says WCVM Dean
E-mail firstname.lastname@example.org communities.” Dr. Charles Rhodes.
Toronto Academy of Veterinary Medicine: Animal Health Network Announced
Update on Clinical Gastroenterology
Dave and Buster’s he Canadian Food Inspection Agency our ability to understand and respond
Toronto, Ontario and the Atlantic Veterinary College to animal health and zoonotic disease
This seminar will provide an update on (AVC) at the University of Prince challenges in a world of ever-changing
gastrointestinal disorders of cats and Edward Island have joined together risks,” said Dr. Brian Evans, chief vet-
dogs, with an emphasis on diagnosis and
treatment. It will offer 5.5 CE credits. in a $1.2-million partnership to create erinary ofﬁcer of Canada.
Phone 800-670-1702 the Canadian Regulatory Veterinary
Web tavm.org Epidemiology Network. This network
will link the ﬁve Canadian veterinary SPREAD YOUR GOOD NEWS
October 13 Have any interesting news to
Toronto Academy of Veterinary colleges and enhance animal health
expertise by contributing to research share? Send it in! We would like
Medicine: Early Resuscitation and
Stabilization of the Emergency Patient and training programs. In addition to to provide more recognition of
Dave and Buster’s veterinarians doing great things in
strengthening Canada’s animal disease
Toronto, Ontario their professional or personal lives.
This seminar will focus on practical prevention and control efforts, the pro-
If you have news about yourself or
emergency management using case gram will also help meet national and a colleague or about some other
examples. It will offer 5.5 CE credits. international demands for animal and newsworthy topic that would be of
Phone 800-670-1702 veterinary health experts. interest to others in the profession,
The initial phase of the project will send it (along with a picture if you
October 18 establish a research chair in regulatory have one) to:
Calgary Academy of Veterinary veterinary epidemiology at the AVC as
Medicine: Hematology Canadian News
well as related graduate positions. The c/o Veterinary Learning Systems
Clara Christie Theatre, Health Sciences
network will be led by the Centre for 780 Township Line Road
University of Calgary, Alberta
This seminar will offer 6 hours of scientiﬁc Veterinary Epidemiological Research at Yardley, PA 19067 USA
CE and be presented by Dr. Marjorie Brooks. the AVC, which is considered one of
Phone 403-863-7160 the leading centres for animal health
E-mail email@example.com FAX 800-556-3288
epidemiologic research in the world. WEB CompendiumVet.com
“This network will further strengthen
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 251
ASSOCIATION OF FELINE
Contributed by: PRACTITIONERS
The American Association of
2008 Feline F
eLV and FIV are among the most common infectious
diseases of cats. Risk factors for infection include male
gender, adulthood, and outdoor access, whereas indoor
In a study of more than 18,000 cats tested
in 2004, 2.3% were positive for FeLV and 2.5%
were positive for FIV.1 Infection rates for FeLV
The decision to vaccinate an individual cat
against FeLV should be based on the cat’s risk
Feline Practitioners improves
the health and well-being of
cats by supporting high stan-
dards of practice, continuing
Retrovirus lifestyle and sterilization are associated with reduced infec-
The retroviral status of all cats should be known. Cats
and FIV (TABLE 1) varied among subpopula-
tions and sources of cats.
of exposure. Cats that live in a FeLV-negative,
indoor environment are at minimal risk.
FeLV vaccination is recommended for:
education, and scientiﬁc inves-
tigation. Feline Practitioners
are veterinary professionals
who belong to this association
may require retrovirus testing at different times in their lives. Preventing FeLV and FIV Infection
because they are “passionate
Here are some general principles for retrovirus testing: Vaccines are available for both retroviruses. All kittens because the lifestyles of kittens fre- about the care of cats”!
Both FeLV and FIV vaccines are non-core. Risk quently change after acquisition and they may American Association of Feline
Guidelines* A cat with a conﬁ rmed-positive test result should be
diagnosed as having a retroviral infection—not clinical dis-
ease. Diseases in cats infected with FeLV or FIV may not
assessment of the individual animal should
dictate their use. No vaccine is 100% effec-
tive, and repeat testing should be performed
subsequently be at risk for FeLV exposure
Cats that go outdoors
Cats that have direct contact with cats of
203 Towne Centre Drive
Hillsborough, NJ 08844-4693
necessarily be the result of the retrovirus infection. as warranted. unknown status or in high-turnover situations phone: 908-359-9351
Members of the Cats infected with FeLV or FIV may live for many years.
Advisory Panel A decision for euthanasia should never be made solely on the
basis of whether the cat is infected.
Media contact: Valerie Creighton,
❯❯ Julie Levy, DVM, PhD, DACVIM, Chair No test is 100% accurate at all times under all conditions. Risk Factors for FeLV and FIV Seropositivity in 18,038 Cats Tested
❯❯ Cynda Crawford, DVM, PhD All test results should be interpreted along with the patient’s at Veterinary Clinics and Animal Shelters in North America1
University of Florida health and prior likelihood of infection. All positive results
Number of Cats Number of Cats
❯❯ Katrin Hartmann, Dr. Med. Vet., Dr. Habil., DECVIN-CA should be conﬁrmed by another test method. Number of Cats
Factor Categories with Positive Results with Positive Results
Ludwig Maximilian University Munich | Munich, Germany Tested
While FeLV and FIV can be life-threatening viruses, proper for FeLV(%) for FIV (%)
❯❯ Susan Little, DVM, DABVP (feline practice) management can give infected cats longer, healthier lives. Study site Animal shelter 8068 124 (1.5) 141 (17)
Winn Feline Foundation | Manasquan, New Jersey The following article reﬂects the recommendations of the
Veterinary clinic 9970 285 (2.9) 305 (3.1)
❯❯ Eliza Sundahl, DVM, DABVP (Feline Practice) AAFP on managing these infections.
KC Cat Clinic | Kansas City, Missouri Region West 3737 39 (1.0) 72 (1.9)
❯❯ Vicki Thayer, DVM, DABVP (Feline Practice) Canada 325 8 (2.5) 10 (3.1)
Purrfect Practice | Lebanon, Oregon The prevalence of FeLV infection has reportedly decreased
during the past 20 years, presumably as a result of implemen- South 6359 144 (2.3) 183 (2.9)
❯❯ Regina Hoffmann-Lehmann, Dr. Med. Vet.,Dr. Habil, FVH
tation of widespread testing programs and development of Northeast 3747 107 (2.9) 79 (2.1)
University of Zurich | Zurich, Switzerland
effective vaccines.1,2,6 In contrast, the prevalence of FIV has
not changed since the virus was discovered in 1986. Midwest 3870 111 (2.9) 102 (2.6)
At a Glance Source Clinic (indoors only) 3613 53 (1.5) 32 (0.9)
Epidemiology Clinic (outdoors access) 6357 232 (3.6) 273 (4.3) Disclaimer
About These Guidelines These guidelines
Shelter (relinquished pet) 2809 41 (1.5) 38 (1.4)
This report is an abridged version of the Retrovirus Guidelines are not exclusive.
Preventing FeLV and FIV Infection
of the American Association of Feline Practitioners (AAFP) to Shelter (stray) 4550 71 (1.6) 75 (1.6) Other techniques and
guide veterinary practitioners who want to optimize the care Shelter (feral) 709 12 (1.7) 28 (3.9) procedures may be
Limiting Transmission in the Veterinary Practice and management of feline patients. It represents a consensus available. The AAFP
of current information compiled by the researchers and Age Juvenile 9556 131 (1.4) 100 (1.0) expressly disclaim
Diagnosing FeLV and FIV practitioners on the panel. Adult 8482 278 (3.3) 346 (4.1) any warranties or
Page XXX The guidelines in this report are based on the best research guarantees, express
Managing Positive Cats data, clinical experience and technical judgments available at Sex Spayed female 2611 45 (1.7) 82 (1.2) or implied, and shall
❯❯ Margie Scherk, DVM,
Page XXX the time of preparation. While the guidelines are as accurate Neutered male 2984 88 (2.9) 127 (4.3) not be liable for any
and comprehensive as possible, they are subject to change damages of any kind
should new insights become available from additional Sexually intact female 6588 128 (1.9) 44 (1.7) in connection with
*This is an abridged version of the full guidelines (Levy JC, research or technological updates. Sexually intact male 5855 148 (2.5) 193 (3.3) the material, informa-
Crawford C, Hartmann K, et al. 2008 American Associa-
The AAFP is a professional organization of practitioners and tion, techniques, or
tion of Feline Practitioners’ feline retrovirus management
DABVP (Feline Medicine)
guidelines. J Feline Med Surg 2008;10:300-316), available board-certiﬁed specialists who seek to raise the standards of Health status Healthy 15,312 238 (1.6) 280 (1.8) procedures set forth
at Catvets.com from the American Association of Feline feline medicine and surgery among practitioners. Sick 2726 171 (6.3) 166 (6.1) in these guidelines.
Practitioners (AAFP). Adapted with permission of AAFP.
472 Compendium | June 2009 | CompendiumVet.com CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 473
Vancouver, British Columbia
The new Feline Focus series begins on page 264.
y now, you know that Compendium is launch- the cornerstone to management and prevention
ing several new series this year, and excite- of the spread of FeLV and FIV and that all cats
ment is building! So what’s new in the should be tested, especially when they are ill?
journal for you and your feline patients? The Vaccination should be considered only in adult
American Association of Feline Practitioners (AAFP) cats that are deemed to live in an at-risk environ-
is partnering with Compendium to shine the ment (i.e., FeLV and FIV vaccines are not core
spotlight on cats on a quarterly basis in Feline for adult cats). However, FeLV vaccination is now
Focus! This series will provide you with pertinent recommended as core for cats younger than 1
and timely updates in feline medicine, covering year. Do you know what the risk for FeLV or FIV
a myriad of useful and useable facts to help you is in your region?
help cats in your practice. It will include brief In addition to providing recommendations on
abstracts and conference pearls; how-to articles preventing retrovirus infections, the guidelines are
about approaching speciﬁc problems in cats, as an excellent source of information about caring for
well as handling and working more peacefully retrovirus-positive cats—not only pet cats but also
and effectively with the more difﬁcult members of those in cattery, shelter, and rescue situations. Do
this species; and summaries of AAFP guidelines. clients ask you whether fencing is adequate for iso-
lation of retrovirus-positive cats from uninfected
While FIV and FeLV vaccines are not cats, or what kinds of disinfectant they need to use?
Do you know how often a cat with FeLV should
considered core for adult cats, FeLV is a be examined and which tests should be conducted
core vaccine for cats younger than 1 year. at each visit, or what drugs have been shown to
be effective in the treatment of FeLV or FIV? If
Every column will be peer-reviewed by a dip- the answers to any of these questions intrigue you,
lomate specialist and approved by a representa- the practical, scientiﬁcally solid article in this issue
tive of the AAFP. Together, Compendium and the should be a useful clinic resource.
AAFP want to provide more access to informa- Welcome to Feline Focus! We look forward to
tion about feline medicine, brought to you by growing a relationship with you based on solid,
sources you know you can trust. practical feline facts.
In this premiere offering of Feline Focus, we
are pleased to share with you the 2008 AAFP Cheers!
Feline Retrovirus Management Guidelines. Not Margie
excited yet? Let me whet your appetite. For exam-
ple, did you know that testing, not vaccination, is
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 257
About This Series
Behavior problems are a signiﬁ-
cant cause of death (euthanasia)
Into General Practice
in companion animals. While most ❯❯ Lisa Radosta, DVM, DACVBa
veterinary practices are necessarily Florida Veterinary Behavior Service | Royal Palm Beach, Florida
geared toward the medical aspect
of care, there are many opportuni-
ties to bring behavior awareness
into the clinic for the beneﬁt of
B ehavior issues affect almost every aspect of veterinary medicine (BOX 1). The
most obvious, such as aggression, fears, and phobias, may be serious enough
to prompt consultation with a behavior specialist. Others, however, may simply
the pet, the owner, and ourselves. be considered “normal,” such as stress during ofﬁce visits or avoidance of a carrier.
This series acknowledges the Although they may not be dramatic, these behaviors can cause clients to limit the
importance of behavior as part of number of nonemergency veterinary visits they make, ultimately affecting a prac-
tice’s bottom line. Therefore, providing basic behavioral services, such as social-
veterinary medicine and speaks
ization or habituation, can not only help increase revenue in general practices but
practically about using it effectively
also improve patient health.
in daily practice.
Why Provide Behavioral Services?
SERIES EDITOR Sharon Crowell- Many general practices do not offer behavioral services for several reasons. The
Davis, DVM, PhD, DACVB
appointments are assumed to be too time-consuming to be proﬁtable (1½ to 3
The University of Georgia
hours), and add-on services and products are not obvious to practices. In addition,
many veterinarians are not comfortable with treating behavior problems. However,
many behavior services can be provided within a 20- to 30-minute appointment,
and although adding a new proﬁt center and retraining employees is a large
investment, the return on investing in behavioral services is sizable. Adding these
services can not only increase client compliance (e.g., medication administration,
scheduling recheck appointments),
retention, and satisfaction but also BOX 1
improve your patients’ quality of
life and decrease the likelihood of Common Circumstances
QuickNotes relinquishment. Clients are often in Which Behavioral Issues
Providing basic embarrassed to share their pet’s Affect General Practice
behavioral services behavior problems or their decision
to relinquish their pet with their vet- Avoidance of cat carrier
can help increase
erinarian. You may not know how Stress during veterinary visit
revenue and improve many patients you lose to behavior
patient health. Difﬁcult handling during veterinary visit
problems each year, but behavior
Intolerance of regular injections/
problems are the leading cause of
relinquishment and euthanasia of
dogs and cats.1–3 Offering behav-
Anxiety during boarding
ioral services is, therefore, a great Aggression in the waiting room
way to attract and retain clients, Lack of compliance with postoperative
reduce stress and euthanasia in your rest recommendations
practice, and even make a proﬁt. By Resistance to nail trimming
Dr. Radosta discloses that she has re-
improving a pet’s behavior, you ulti- Relinquishment of pets for treatable
ceived ﬁnancial support from Eli Lilly mately help the pet, the client, and problems
and Company and Virbac Animal Health. the practice.
258 CompendiumVet.com | June 2009
listen to their cats.
Listen to your cat owners.
Cats and their owners agree: a topical dewormer beats a pill any day. In fact, nearly 90% of cat
owners prefer topical drops to pills or tablets.* So listen to your cat owners. Choose the only feline
dewormer that treats and controls roundworms, hookworms and tapeworms with the ease and
convenience of a topical application: Profender® Topical Solution.
*From a survey of 736 cat owners. Data on file.
Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian.
Children should not contact application site for twenty-four (24) hours.
See Page 260 for Product Information Summary
Where to Begin
Planning for New Services
First, decide which levels of care
your practice can provide. Examples
include prepurchase counseling,
doggie day care, preventive medicine,
behavior modiﬁcation for simple or
major problems, basic obedience
classes, behavioral consultation for
major problems, and referral to a
Next, decide how you will del-
egate the responsibilities to your
team. Your role as the veterinar-
ian is to diagnose the problem and
write a treatment plan. Just as you
would not ask a technician to make
the treatment plan for a dog with
acute pancreatitis, you should not
turn the responsibility to diagnose
and treat behavior problems over
to a technician. So, what will the
technician’s role be? Will he or she
implement the treatment plan for
you or be responsible for phone
follow-up and follow-up appoint-
ments? What will the receptionist’s
role be? All members of the prac-
tice should be on board with the
plan for it to be effective.
Next, think about how you will
train your staff. Some resources for
education are textbooks, continuing
education courses, and professional
organizations (BOX 2). Contact your
nearest board-certiﬁed veterinary
behaviorist and ask which text-
books and conferences he or she
recommends or whether he or she
would be willing to talk to your
staff to get the ball rolling.
Finally, consider how to make
behavioral services simple and acces-
sible for clients. Easy-to-understand
client handouts explaining the
diagnosis and treatment should
be used to help keep appoint-
ments to a reasonable length of
time. Handouts can be written by
staff and edited by the veterinar-
ian, or prewritten handouts can be
found in a number of textbooks
(BOX 2). Handouts can also be inte-
grated into a computer-generated behavior at each appointment. By
discharge sheet so that all client incorporating behavioral issues
instructions are in the same place. into routine wellness visits, you
The number of handouts and the foster the idea that behavior is
topics to be covered will depend just another aspect of the patient
on the services offered at the prac- to be examined.
tice. Also, decide which behavior- Similarly, the practice should
related products the practice will support the message that behav-
carry, as this will be an important ioral problems should be treated
part of completely integrating as promptly as medical illnesses.
behavior services. For example, when you write
a medical treatment plan, the
Integrating New Services practice pharmacy dispenses
Into the Practice the necessary medications (e.g.,
For any service to be a successful an antibiotic for superﬁcial pyo-
practice builder, it must be inte- derma). Although other phar-
grated into the practice, from the macies may dispense the same
receptionist to the veterinarian. From the moment medication at a lower price, dispensing from the
that clients enter the waiting room, they should be practice pharmacy allows clients to begin treatment
aware that you provide behavioral services. Signs immediately and conveniently. Behavior cases are
unique to the practice or supplied by toy manufac- no different. Behavioral supplies (e.g., food toys,
turers or pharmaceutical companies are one way of collars, clickers) should be displayed prominently in
achieving this goal. The receptionist should men- the lobby. Although clients can pur-
tion the addition of behavioral services to the prac- chase these products elsewhere at QuickNotes
tice when clients book appointments and should a later time, they are more likely to
give each arriving client a short behavior checklist initially purchase them from the vet- Behavioral medicine
(BOX 3) to be ﬁlled out while waiting. The client can erinarian at the time of the appoint- can be a proﬁt cen-
then give the completed form to the technician at ment because the product is unique ter for primary care
the beginning of the visit. Using a form is the most to the veterinarian’s ofﬁce (e.g., Blue practices.
efﬁcient way of collecting information about a pet’s Kong) or was “prescribed” as part of
the treatment plan.
BOX 2 What to Offer
Resources Prepurchase counseling helps owners avoid prob-
lems of incompatibility by suggesting a pet that
Textbooks matches their lifestyle. These appointments typi-
Horwitz D, Mills D, Heath S, eds. BSAVA Manual cally take 20 to 30 minutes and can be conducted
of Canine and Feline Behavioural Medicine. by a veterinary technician. Technicians can educate
Gloucester, England: BSAVA; 2002. themselves by using Internet resources (e.g., akc.
org, iams.com, purina.com), attending continu-
Landsberg G, Ackerman L, Hunthausen W.
ing education classes, and familiarizing themselves
Handbook of Behavior Problems of the Dog
with breed handbooks. Before the appointment,
and Cat. Philadelphia: Elsevier; 2003.
the owner ﬁlls out a 1- to 2-page questionnaire list-
Organizations ing his or her expectations for a pet (e.g., groom-
American College of Veterinary Behaviorists: ing, exercise, energy level). The technician should
www.dacvb.org consider the owner’s ability to exercise the pet, the
amount of time available for training, the presence
American Veterinary Society of Animal of children in the household, grooming require-
Behavior: www.avsabonline.org ments, and the owner’s travel/work schedule. The
Society of Veterinary Behavior Technicians: client should be sent home with a summary of rec-
www.svbt.org ommendations, which can be as simple as a list of
breeds with the suitable candidates checked off.
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 261
Doggie Day Care training, crate training, and socialization to people
In today’s busy society, many owners do not have and other animals can be conducted. While this
the time to adequately exercise their dogs, which may seem like a large task, it requires little more
can contribute to several behavior problems. By time and commitment than boarding patients. Crate
instituting a doggie day care program, your prac- training and housetraining of dogs include walk-
tice can offer your clients several beneﬁts. To clients ing them on a schedule and teaching them that the
who pick up their dog after a long day of work, the crate is a fun place to be. Socialization to people
most obvious beneﬁt will be the dog’s reduced need takes roughly 5 to 10 minutes, three times a day.
for activity. This aspect of the service will build cli- Clients who are in your clinic waiting for their own
ent loyalty and encourage clients to continue to use pets can help by playing with puppies and kittens
the day care. Another beneﬁt of a good doggie day in a clean, safe area, adding to socialization with-
care program is screening for common infectious out placing a drain on the practice. However, these
diseases and aggression (via a questionnaire), which services require a separate puppy/kitten area that is
should be required for all dogs before they are per- kept clean and free of any pets with infectious dis-
mitted to participate. eases, and owners of pets with infectious diseases
Doggie day care requires a signiﬁcant commit- should not participate.
ment of space and dedicated staff. A medium-to- Clients may want to complete the socialization of
large room or yard is necessary. Outdoor yards their pet themselves but not know how to do so. In
should have secured fencing of adequate height to these cases, the veterinarian can customize a plan,
contain large dogs. Agility equipment, beds, crates, based on the pet’s strengths and weaknesses, for the
and toys can also be provided. Ideally, there should client to implement at home. Appointments gener-
be at least three separate areas for small dogs, large ally last 20 to 30 minutes. The client should leave the
dogs, and older dogs. Dogs should appointment with a summary and a handout on which
QuickNotes be rotated between rest and play in the appropriate recommendations are checked off.
appropriate groups, depending on Puppy and kitten socialization classes are vitally
Behavioral issues their play style. All interactions should important in preventing behavioral disorders.4
affect almost every be supervised by at least one person Because the classes should be limited in size and
aspect of veterinary for every four or ﬁve dogs. Upgrades the patients are small, there is no need for a large
medicine. such as baths and viewing by webcam space. During these classes, pets are socialized to
can also be offered. people and other pets, habituated to sounds and
handling, and taught to tolerate nail trims and tooth
Preventive Medicine brushing. Finally, they are taught basic obedience
Veterinarians practice preventive medicine every day, behaviors. These positive-reinforcement classes can
but behavioral advice is frequently left out. Puppies be taught by a veterinarian or a member of the staff.
and kittens have sensitive periods for socialization Puppies and kittens should be enrolled when they
in which a relatively small amount of effort can have are as close to 8 weeks of age as possible to offer
a very large effect. Unfortunately, if their experi- the greatest beneﬁt to the pet and client.
ences during these periods are stressful, or if they
are not exposed to new people and situations dur- BOX 3
ing this time, they often become fearful or anxious.
Fears and anxieties are the most common causes of Waiting-Room Behavior Checklist
behavior problems, including aggression, in animals.
Therefore, each new puppy or kitten appointment Have your pet’s elimination habits changed since
should include counseling about socialization and his/her last appointment?
habituation. In addition, the practice can offer in- Has your pet growled at or bitten someone since
house socialization/habituation services, kitten and his/her last appointment?
puppy classes, obedience classes, and counseling Has your pet had an increase in anxiety or fear
services for life/schedule changes. since his/her last appointment?
In-house socialization/habituation services for Has your pet’s personality changed since his/her
puppies and kittens reduce clients’ time commit- last appointment?
ment to this type of training. Instead, clients bring Are any of your pet’s behaviors of concern to
their pets to the clinic, where habituation to star- you?
tling noises (e.g., thunderstorms, ﬁreworks), house-
262 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
a standard part of treating a medical disorder. Some
examples are muzzle training for veterinarian-aggres-
sive dogs, behavior modiﬁcation for cats that will not
enter their carriers, and counterconditioning for pets
that do not tolerate medication administration. When
topical, oral, or injectable medications are prescribed,
the client should be asked if he or she will be able
to administer the medication for the duration of the
treatment plan. If the answer is “no,” a behavior modi-
ﬁcation appointment should be recommended.
Problem Behavior Referrals
Appointments for problem behaviors typically last
1½ to 3 hours. Most general practices choose not to
offer these appointments because of their length and
proﬁtability compared with other services. If this is
the case in your practice, you can offer an initial
30-minute consult preceding a referral to a board-
certiﬁed veterinary behaviorist. These visits include
a physical examination, screening laboratory tests
(e.g., complete blood count, serum chemistry pro-
ﬁle, thyroxine, urinalysis), and a short list of ﬁve to
Obedience classes can be offered at the clinic. 10 safety recommendations speciﬁc to the case (e.g.,
A member of the staff can teach the class, or the avoidance of provocative situations, discontinuation
clinic can partner with a dog trainer. Such classes of physical corrections or confrontational interac-
can be a good way to supplement income, increase tions). By offering this service, you ensure that the
employee job satisfaction and retention, and intro- patient has had a recent medical workup before it
duce new clients to your practice. However, these goes to the behavior specialist and that this income
classes should be undertaken with care because the stays in your practice. In addition, screening tests
practice may be legally responsible for the advice may help identify, and allow you to start treatment
given. Regardless of who you employ to teach obe- for, an underlying medical disorder that may be con-
dience or puppy classes, observe them teaching ﬁrst. tributing to the behavior problem.
Ask them what methods they use and how much
experience they have. Lay down guidelines for pos- Conclusion
itive-reinforcement training in writing so that there There are many ways to integrate behavioral medi-
is no confusion about what is permitted. cine into the general veterinary practice. Change is
Counseling services can help clients transition their never easy or comfortable, but by adding behav-
pets in circumstances such as moving, marriage, loss ioral services to your practice, you can improve your
of a family member (animal or human), or arrival of patients’ quality of life; increase patient, client, and
a baby. Even the best pet can become agitated by employee retention; and positively affect your prac-
major life changes. Appointments generally last 20 to tice’s bottom line.
30 minutes. As with a medical appointment, the tech-
nician takes the history and presents the case to the References
veterinarian. The veterinarian examines the pet and 1. Patronek FJ, Glickman LT, Beck AM,an al. Risk
factors for relinquishment of dogs to
makes an assessment and a treatment plan. After pre- shelter. JAVMA 1996;209:572-581.
senting the plan to the client, the technician teaches 2. Patronek GJ, Glickman LT, Beck AM, et al. TO LEARN
Risk factors for relinquishment of cats to an ani-
the client how to implement it and sends him or her mal shelter. JAVMA 1996;209:582-598.
home with an appropriate handout. 3. Salman MD, Hutchinson J, Ruch-Gallie R, et al.
Behavioral reasons for relinquishment of dogs and
cats to 12 shelters. J Appl Anim Welf Sci 2000;3(2):
Basic Behavior Modification 93-106. For a sample waiting room
Basic behavior modiﬁcation appointments last 20 to 4. Duxbury MM, Jackson JA, Line SW, Anderson questionnaire, please visit
RK. Evaluation of association between retention in flvetbehavior.com.
30 minutes and are conducted either by the techni- the home and attendance at puppy socialization
cian after the veterinarian has examined the pet or as classes. JAVMA 2003;223:62-66.
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 263
eLV and FIV are among the most common infectious
diseases of cats. Risk factors for infection include male
Retrovirus gender, adulthood, and outdoor access, whereas indoor
lifestyle and sterilization are associated with reduced infec-
Management The retroviral status of all cats should be known. Cats
may require retrovirus testing at different times in their lives.
Here are some general principles for retrovirus testing:
Guidelines* A cat with a conﬁ rmed-positive test result should be
diagnosed as having a retroviral infection—not clinical dis-
ease. Diseases in cats infected with FeLV or FIV may not
Members of the necessarily be the result of the retrovirus infection.
Cats infected with FeLV or FIV may live for many years.
Advisory Panel A decision for euthanasia should never be made solely on the
❯❯ Julie Levy, DVM, PhD, DACVIM, Chair basis of whether the cat is infected.
❯❯ Cynda Crawford, DVM, PhD No test is 100% accurate at all times under all conditions.
University of Florida All test results should be interpreted along with the patient’s
❯❯ Katrin Hartmann, Dr. Med. Vet., Dr. Habil., DECVIN-CA health and prior likelihood of infection. All positive results
Ludwig Maximilian University Munich | Munich, Germany should be conﬁrmed by another test method.
❯❯ Regina Hoffmann-Lehmann, Dr. Med. Vet., Dr. Habil, FVH
University of Zurich | Zurich, Switzerland While FeLV and FIV can be life-threatening viruses, proper
❯❯ Susan Little, DVM, DABVP (Feline Practice) management can give infected cats longer, healthier lives.
Winn Feline Foundation | Manasquan, New Jersey The following article reﬂects the recommendations of the
AAFP on managing these infections.
❯❯ Eliza Sundahl, DVM, DABVP (Feline Practice)
KC Cat Clinic | Kansas City, Missouri
❯❯ Vicki Thayer, DVM, DABVP (Feline Practice)
Purrfect Practice | Lebanon, Oregon About These Guidelines
This report represents a consensus of current information
At a Glance compiled by the researchers and practitioners on the panel.
These guidelines are based on the best research data, clinical
Epidemiology experience and technical judgments available at the time
Page 265 of preparation. While the guidelines are as accurate and
Preventing FeLV and FIV Infection comprehensive as possible, they are subject to change should
Page 265 new insights become available from additional research or
Limiting Transmission in the Veterinary Practice technological updates.
Page 268 The American Association of Feline Practitioners is a
professional organization of practitioners and board-certiﬁed
Diagnosing FeLV and FIV specialists who seek to raise the standards of feline medicine
and surgery among practitioners.
Managing Positive Cats
* This is an abridged version of the full guidelines (Levy JC,
MORE ON Compendium grants permission to
Crawford C, Hartmann K, et al. 2008 American Associa- THE WEB reproduce this article for educational
tion of Feline Practitioners’ feline retrovirus management purposes. A downloadable version
guidelines. J Feline Med Surg 2008;10:300-316) available of this article is available on
at catvets.com from the American Association of Feline CompendiumVet.com.
Practitioners (AAFP). Adapted with permission from AAFP.
264 Compendium | June 2009 | CompendiumVet.com
ASSOCIATION OF FELINE
Contributed by PRACTITIONERS
The American Association of
Epidemiology FeLV Vaccination Feline Practitioners improves
The prevalence of FeLV infection has report- The decision to vaccinate an individual cat the health and well-being of
cats by supporting high stan-
edly decreased during the past 20 years, pre- against FeLV should be based on the cat’s risk
dards of practice, continuing
sumably as a result of implementation of of exposure. Cats that live in an FeLV-negative, education, and scientiﬁc inves-
widespread testing programs and develop- indoor environment are at minimal risk. tigation. Feline Practitioners
ment of effective vaccines.1,2,6 In contrast, the FeLV vaccination is recommended for: are veterinary professionals
who belong to this association
prevalence of FIV has not changed since the
because they are “passionate
virus was discovered in 1986. All kittens because the lifestyles of kittens about the care of cats”!
In a study of more than 18,000 cats tested frequently change after acquisition, and kittens American Association of Feline
in 2004, 2.3% were positive for FeLV and 2.5% may subsequently be at risk for FeLV exposure Practitioners
203 Towne Centre Drive
were positive for FIV.1 Infection rates for FeLV Cats that go outdoors Hillsborough, NJ 08844-4693
and FIV (TABLE 1) varied among subpopula- Cats that have direct contact with cats of phone: 800-874-0498
tions and sources of cats. unknown status or in high-turnover situations phone: 908-359-9351
such as foster homes or other group housing
Preventing FeLV and FIV Infection Cats that live with FeLV-positive cats
Media contact: Valerie Creighton,
Vaccines are available for both retroviruses. Both DVM, DABVP
FeLV and FIV vaccines are non-core. Risk assess- Because sufﬁcient protection is not induced
ment of the individual animal should dictate their in all vaccinates, vaccination against FeLV does
use. No vaccine is 100% effective, and repeat not diminish the importance of testing cats to
testing should be performed as warranted. identify and isolate those that are viremic. In
Risk Factors for FeLV and FIV Seropositivity in 18,038 Cats Tested
at Veterinary Clinics and Animal Shelters in North America1
Number of Cats Number of Cats
Number of Cats
Factor Categories With Positive Results With Positive Results
for FeLV (%) for FIV (%)
Study site Animal shelter 8068 124 (1.5) 141 (1.7)
Veterinary clinic 9970 285 (2.9) 305 (3.1)
Region West 3737 39 (1.0) 72 (1.9)
Canada 325 8 (2.5) 10 (3.1)
South 6359 144 (2.3) 183 (2.9)
Northeast 3747 107 (2.9) 79 (2.1) Disclaimer
Midwest 3870 111 (2.9) 102 (2.6) These guidelines
Source Clinic (indoors only) 3613 53 (1.5) 32 (0.9)
are not exclusive.
Other techniques and
Clinic (outdoors access) 6357 232 (3.6) 273 (4.3)
procedures may be
Shelter (relinquished pet) 2809 41 (1.5) 38 (1.4) available. The AAFP
Shelter (stray) 4550 71 (1.6) 75 (1.6) expressly disclaims
Shelter (feral) 709 12 (1.7) 28 (3.9) any warranties or
Age Juvenile 9556 131 (1.4) 100 (1.0) guarantees, express
Adult 8482 278 (3.3) 346 (4.1)
or implied, and shall
not be liable for any
Sex Spayed female 2611 45 (1.7) 44 (1.7)
damages of any kind
Neutered male 2984 88 (2.9) 127 (4.3) in connection with
Sexually intact female 6588 128 (1.9) 82 (1.2) the material, informa-
Sexually intact male 5855 148 (2.5) 193 (3.3) tion, techniques, or
Health status Healthy 15,312 238 (1.6) 280 (1.8) procedures set forth
Sick 2726 171 (6.3) 166 (6.1)
in these guidelines.
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 265
addition, cats should be tested for FeLV infec- Current FIV antibody tests cannot dis-
tion before initial vaccination and whenever tinguish vaccinated cats from infected
the possibility exists that they have been cats. Clients should be informed that vacci-
QuickNotes exposed to FeLV since they were last tested. nated cats will have positive FIV test results,
The retroviral status Administering FeLV vaccines to cats conﬁrmed and the decision to vaccinate should be
of all cats should to be FeLV infected is of no value. reached only after careful consideration of
this implication. If the decision falls in favor
be known because
FIV Vaccination of vaccination, cats should test negative
the serious health The decision to vaccinate a cat for FIV is com- immediately before vaccination.
consequences of plicated. FIV vaccines may be considered for A permanently placed identiﬁcation micro-
infection inﬂuence cats with lifestyles that put them at high risk chip and collar are recommended for all cats
patient manage- for infection, such as outdoor cats that ﬁght or to increase the chance of returning lost cats to
ment both in illness cats living with FIV-infected cats. Because FIV their owners. Microchip databases can also
and wellness care. infection is more often spread by unfriendly record FIV vaccination histories. This infor-
exchanges (usually biting), cats in households mation can be used by animal shelters to help
with a stable social structure are at lower risk assess the significance of positive FIV test
for acquiring FIV infection. results when screening cats before adoption.
General Recommendations for Testing for and Controlling
Transmission of FeLV and FIV in Shelters and Breeding Catteries
Testing tiple samples for use in a single test status, vaccination against FeLV and
As for pet cats, it is ideal for all cats in reduce test sensitivity and should not FIV is not necessary.
shelters and catteries to be tested for be performed. Vaccination is not 100% effective and
FeLV and FIV.* Foster families and adopters should should never be used in place of a
Testing at admission is optional for have their own resident cats tested test-and-segregate program.
singly housed cats. before fostering or adopting a new cat. In contrast to feline panleukopenia,
Testing is highly recommended for Testing is optional in feral cat trap– herpesvirus, and calicivirus vaccines,
group-housed cats. neuter–return programs. the value of a single FeLV vaccine for
If not performed before adoption, feral cats has not been determined.
testing should be recommended to Controlling Transmission Therefore, FeLV vaccination is not rec-
the new owner before exposure to FeLV vaccination is optional for singly ommended for feral cat trap–neuter–
other cats. housed cats. return programs if program resources
Testing should be repeated 60 days af- FeLV vaccination is highly recom- are needed for higher priorities.
ter the initial test and annually for cats mended for all cats housed in groups FIV vaccination is not recommended
kept in long-term group housing. and for foster cats and permanent for use in shelters or feral cats.
Each cat should be individually tested. residents in foster homes. Strict adherence to universal precau-
Testing representative kittens in a litter Cats should test negative before vac- tions is required to prevent iatrogenic
or colony and extrapolating results to cination. transmission of retroviruses in the
other cats in the group is unreliable. In catteries that follow testing guide- shelter environment via contaminated
Procedures such as pooling mul- lines and maintain retrovirus-negative equipment and secretions.
*Currently, no test can distinguish FIV antibodies induced by infection from those induced by vaccination. Therefore, shelters have the difﬁcult
task of determining the true infection status of stray cats that are admitted without medical histories and that test positive for FIV antibodies.
If the cat is microchipped, the history of FIV vaccination may be recorded in an accessible database. However, even if cats are known to have
been vaccinated against FIV, determining whether they are also infected is not usually possible. This is a challenge for shelters for which no
solution currently exists.
266 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
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Limiting Transmission BOX 2
in the Veterinary Practice FeLV and FIV Diseases
Retroviruses are unstable outside their host
animals and can be quickly inactivated by Although many FeLV-/FIV-infected cats
detergents and routine disinfectants.7–11 Simple experience prolonged survival, retroviral
precautions and routine cleaning procedures infections can be associated with:
prevent transmission of these agents in veteri-
Secondary and opportunistic infections
As a guide:
Chronic inﬂammatory conditions
All infected patients should be housed in Ocular disorders
individual cages when hospitalized and not in Hematologic disorders
isolation/contagious wards where they may be
exposed to infectious agents. Speciﬁc diseases associated with very high
Hospital staff should wash their hands rate of infection:
between patients and after cleaning cages. Cutaneous abscesses (FeLV: 8.8%, FIV:
Because FeLV and FIV can be transmitted in 12.7%)12
blood transfusions, donors should be tested Oral inﬂammation (FeLV: 7.3%, FIV: 7.9%)a
before donating. A real-time polymerase chain
reaction (PCR) test for FeLV is recommended a
Bellows J, Lachtara JL. Feline retroviruses and
QuickNotes for blood donors because proviral elements in
oral disease [unpublished]. Reported in: Veterinary
seronegative cats with regressive FeLV infection Medicine, “Spotlight on Research”; 2006.
Retroviruses can may cause infection in transfusion recipients.
be quickly inac-
tivated by deter- FIGURE 2
gents and routine FeLV
FeLV antigen positive FeLV antigen negative
All positive results should be conﬁrmed. Negative screening test results are highly
reliable. However, if results are negative but
recent infection cannot be ruled out, testing
should be repeated a minimum of 30 days
Retest immediately with IFA. after the last potential exposure.
FeLV IFA positive FeLV IFA negative
Consider FeLV infected and start appropriate Discordant results may be due to the stage of infection, the
management program. variability of host responses, or technical problems with
testing. It is not usually possible to determine the true FeLV
infection status of cats with persistently discordant test results.
If resolving is desired, retest in 60 days
using antigen and IFA.
FeLV test interpretation algorithm—all cats. IFA = immunofluorescence assay
268 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
Dental and surgical instruments, endotracheal Cats should be tested when they are:
tubes, and other items potentially contami-
nated with body ﬂuids should be thoroughly Sick, regardless of age, despite previ-
cleaned and sterilized between uses. ous negative test results or previous vac-
Fluid lines, multidose medication containers, cination. FeLV and FIV are associated with
and food can become contaminated with body a wide variety of health disorders4,5 (BOX 2).
ﬂuids (especially blood or saliva) and should Identiﬁcation of retroviral infection as a com-
not be shared among patients. plicating factor can assist in the development
of optimal management plans.
Recommendations on testing for and control- About to be adopted or brought into a
ling transmission of FeLV and FIV in shelters new household, regardless of age. Even
and catteries are listed in BOX 1. if no other cats are present in the household,
testing will protect future cats that may join the
Diagnosing FeLV and FIV family as well as neighborhood cats, should
The retroviral status of all cats should be known the pet escape or be allowed outside.
because the serious health consequences of At risk of exposure, even if their most
infection inﬂuence patient management both recent test was negative. As an example,
in illness and wellness care. Failure to identify a 2008 study12 showed that more than 19%
infected cats may lead to inadvertent exposure of cats with cutaneous abscesses were FIV
and transmission to uninfected cats. Misdiagnosis or FeLV positive at the time of presentation.
of infection in uninfected cats may lead to inap- Because of delay in seroconversion after initial QuickNotes
propriate changes in lifestyle or even euthanasia. infection, these cats should also be retested (a
ELISA and other
FIV graphic tests are the
Antibody test tests for FeLV and
FIV antibody positive FIV antibody negative
All positive results should be conﬁrmed. Negative screening test results are highly
Cats vaccinated with a whole-virus vaccine reliable. However, if results are negative but
will test antibody positive. recent infection cannot be ruled out, testing
should be repeated a minimum of 60 days
Retest with another antibody test. after the last potential exposure.
< 6 Months of age > 6 Months of age
Retest at 60-day intervals Retest immediately with different test
FIV antibody positive FIV antibody negative FIV antibody positive FIV antibody negative
If positive after kitten If negative at any Consider FIV infected Consider free of infection
reaches 6 months of age, interval, consider free and continue appropriate and begin a wellness
consider FIV infected. of infection and begin a management program. program.
Note: False-positive results
will exist in vaccinated cats.
FIV test interpretation algorithm—all cats.
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 269
minimum of 30 days after the last potential from a different manufacturer.18,19 Western blot
FeLV exposure and 60 days after potential FIV tests have been the recommended conﬁrma-
exposure). tion tests in the past, but they were found to be
Of “unknown” viral status. Infected cats less sensitive and speciﬁc than in-clinic screen-
can remain asymptomatic for years, during ing tests in one study.17
which time they may serve as hidden sources Vaccination of cats against FIV induces anti-
of infection to other cats in the household. FIV antibodies that cannot be distinguished
About to be vaccinated against FeLV or from natural infection. These antibodies per-
FIV. These vaccines should not be administered sist for at least 1 year and can be transferred in
to cats that are already infected. Vaccination colostrum to kittens.
does not affect the carrier state, the capacity While PCR assays may help distinguish cats
to infect other cats, or the development of dis- infected with FIV from cats vaccinated against FIV,
ease in cats with preexisting infection. one study found marked variability in diagnostic
accuracy among commercial laboratories.20
Diagnosis of FeLV
Soluble-antigen tests are preferred for initial
screening (FIGURE 1). These include ELISA and Negative results for either FeLV or FIV
other immunochromatographic tests. are much more reliable than positive results
While screening tests detect the presence of because of the low prevalence of infec-
free antigen in the circulating blood, the immu- tion in most cat populations. Positive test
noﬂuorescence assay (IFA) tests for the presence results should be conﬁrmed, especially in
QuickNotes of antigen within infected white blood cells and asymptomatic and low-risk cats. No test is
platelets. Positive results from tests that detect 100% accurate all the time, under all con-
Both FeLV-infected free antigen may be reﬂective of the transient ditions. In cat populations with a low
and FIV-infected period of antigenemia associated with regres- prevalence (e.g., <1%), more than half of the
cats can live for sive infections. Positive results from tests that cats that test positive are likely to be uninfected.21
many years. detect cell-associated antigen, such as the IFA, Kittens may be tested for FeLV and FIV at
are likely to be reﬂective of progressive infec- any age. Most kittens test negative, indicat-
tions. Tests that use saliva and tears yield an ing no infection. Antibody tests for FIV can
unacceptably high percentage of inaccurate detect antibodies passed in colostrum from
results, and their use is not recommended.13 an infected or vaccinated mother, which can
Although there are no published assessments be mistaken for infection in the kitten. Kittens
of diagnostic accuracy of PCR testing for FeLV, that test positive for FIV antibodies should
the test is offered by a number of commercial be retested every 60 days up to 6 months
laboratories. Recent studies14,15 using real-time of age. If the kitten becomes seronegative, it
PCR have shown that 5% to 10% of cats with most likely is not infected. If results of tests
negative results on soluble antigen tests were performed after 6 months of age are still con-
positive for FeLV provirus by PCR (regressive ﬁrmed positive, these kittens should be con-
infection). sidered infected.
FeLV vaccinations will not induce positive
Diagnosis of FIV test results.
FIV produces a persistent, lifelong infection, FIV vaccinations will induce positive test
so detection of antibodies in peripheral blood results.
has been judged sufﬁcient for routine diagnos-
tic screening if the cat has not been previously Managing Positive Cats
vaccinated against FIV and has not acquired Both FeLV-infected and FIV-infected cats can
FIV antibodies in colostrum16,17 (FIGURE 2). live for many years and may succumb at older
ELISA and other immunochromatographic ages to causes unrelated to their retrovirus
tests are the preferred screening tests. Conﬁr- infections. In recent studies,22 the median sur-
mation of positive screening tests should include vival after diagnosis of FeLV-infected cats was
a different method or at least an antibody test 2.4 years; for FIV-infected cats, it was 4.9 years.
270 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
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Thus, a decision for treatment or for euthana- Infected queens should not be bred and
sia should never be based solely on the pres- should be spayed if their condition is suf-
ence of a retrovirus infection. ficiently stable to permit them to undergo
Managing Healthy Positive Cats
Examinations should be performed at least Managing Clinically Ill Positive Cats
twice a year. At each visit: Prompt and accurate diagnosis is essential to
allow early therapeutic intervention and a suc-
Update medical history. Monitor for any signs cessful treatment outcome. Therefore, inten-
of weight loss. sive diagnostic testing should proceed early in
Perform a thorough physical examination; pay the course of illness for infected cats. Many
close attention to the lymph nodes, eyes, and cats infected with FeLV or FIV respond as well
oral cavity. as their uninfected counterparts to appro-
Conduct a complete blood count, biochemi- priate medications and treatment strategies,
cal analysis, urinalysis, and fecal examination although a longer or more aggressive course
at least once a year. FeLV-positive cats may of treatment may be needed.
need a complete blood count twice a year. Few attempts have been made to evaluate
Spay or neuter intact cats. antiviral drugs, immunomodulators, or alter-
Control internal and external parasites. native therapies in large controlled studies of
Vaccinate as lifestyle indicates. Most retrovirus- naturally infected cats. To date, no treatment
infected cats mount adequate immune responses has been shown to reverse well-established
when vaccinated, and there is no need to modify retrovirus infection in cats.
standard vaccination intervals.23 There is controversy Clients with a healthy or ill retrovirus-
about the use of inactivated versus modiﬁed-live positive cat may be frightened by the initial
vaccines. Current recommendations are to use inac- diagnosis. It is important to alleviate these
tivated vaccine products due to the theoretical risk of fears when appropriate and offer encouraging
a modiﬁed-live product regaining its pathogenic- advice on the proper care and management of
ity in cats with compromised immune systems. the cat (BOX 3).
Advice for Owners of Infected Cats
Limiting Transmission at Home Don’t Introduce—If separation is not possible,
Conﬁne—Infected cats should be conﬁned no new cats should be introduced in the house-
indoors so they do not pose a risk of hold to reduce the risk of territorial aggression.
infection to other cats and so they are
protected against infectious hazards in If owners choose not to separate retrovirus-
the environment. infected housemates from their other cats,
Isolate—The best method of preventing the uninfected cats should be considered for
spread to other cats in the household is to vaccination. Vaccinated cats should be isolated
isolate the infected cat from interacting with from infected cats for at least 2 months after
its housemates. Isolation in a separate room the vaccine series.
is recommended, but a simple screen or
chain-link barrier is adequate. Generally, FeLV Managing Positive Cats
transmission is low in households with stable Watch closely for behavioral changes in the cat.
social structures where housemates do not Feed a nutritionally balanced diet. Avoid raw
ﬁght, but FeLV can still be transmitted via diets because of the risk of food-borne bacte-
friendly interactions. rial and parasitic infections.
272 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
1. Levy JK, Scott HM, Lachtara JL, Crawford PC. Seroprevalence of feline rus testing. JAVMA 2008;232:1152-1158.
leukemia virus and feline immunodeﬁciency virus infection among cats in 13. Panel report on the colloquium on feline leukemia virus/feline immunodeﬁ-
North America and risk factors for seropositivity. JAVMA 2006;228:371- ciency virus: tests and vaccination. JAVMA 1991;199:1273-1277.
376. 14. Hofmann-Lehmann R, Huder JB, Gruber S, et al. Feline leukemia provi-
2. O’Connor TP Jr, Tonelli QJ, Scarlett JM. Report of the National FeLV/FIV rus load during the course of experimental infection and in naturally infected
Awareness Project. JAVMA 1991;199:1348-1353. cats. J Gen Virol 2001;82:1589-1596.
3. Levy JK, Crawford PC. Feline leukemia virus. In: Ettinger SJ, Feldman 15. Gomes-Keller MA, Go¨nczi E, Tandon R, et al. Detection of feline leu-
EC, eds. Textbook of Veterinary Internal Medicine. 6th ed. Philadelphia: WB kemia virus RNA in saliva from naturally infected cats and correlation of
Saunders; 2005:653-659. PCR results with those of current diagnostic methods. J Clin Microbiol
4. Hoover EA, Mullins JI. Feline leukemia virus infection and diseases. JAV- 2006;44:916-922.
MA 1991;199:1287-1297. 16. Hartmann K. Feline immunodeﬁciency virus infection: an overview. Vet J
5. Levy JK. Feline immunodeficiency virus update. In: Bonagura J, ed. Current Veteri- 1998;155:123-137.
nary Therapy XIII. Philadelphia: WB Saunders; 2000:284-288. 17. Levy JK, Crawford PC, Slater MR. Effect of vaccination against fe-
6. Moore GE, Ward MP, Dhariwal J, Al E. Use of a primary care veterinary line immunodeﬁciency virus on results of serologic testing in cats. JAVMA
medical database for surveillance of syndromes and diseases in dogs and 2004;225:1558-1561.
cats. J Vet Intern Med 2004;18:386. 18. Barr MC. FIV, FeLV, and FIPV: interpretation and misinterpretation of sero-
7. Francis DP, Essex M, Gayzagian D. Feline leukemia virus: survival under home logical test results. Semin Vet Med Surg Small Anim 1996;11:144-153.
and laboratory conditions. J Clin Microbiol 1979;9:154-156. 19. Hartmann K, Werner RM, Egberink H, Jarrett O. Comparison of six in-
8. van Engelenburg FA, Terpstra FG, Schuitemaker H, Moorer WR. The house tests for the rapid diagnosis of feline immunodeﬁciency and feline leu-
virucidal spectrum of a high concentration alcohol mixture. J Hosp Infect kemia virus infections. Vet Rec 2001;149:317-320.
2002;51:121-125. 20. Bienzle D, Reggeti F, Wen X, et al. The variability of serological and
9. Moorer WR. Antiviral activity of alcohol for surface disinfection. Int J molecular diagnosis of feline immunodeﬁciency virus infection. Can Vet J
Dent Hyg 2003;1:138-142. 2004;45:753-757.
10. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens per- 21. Jacobson RH. How well do serodiagnostic tests predict the infection or
sist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130. disease status of cats? JAVMA 1991;199:1343-1347.
11. Terpstra FG, Van Den Blink AE, Bos LM, et al. Resistance of surface-dried 22. Levy JK, Lorentzen L, Shields J, Lewis H. Long-term outcome of cats with
virus to common disinfection procedures. J Hosp Infect 2007;66:332-338. natural FeLV and FIV infection. In: 8th Int Feline Retrovirus Res Symp 2006.
12. Goldkamp CE, Levy JK, Edinboro CH, Lachtara JL. Seroprevalences of feline 23. Richards JR, Elston TH, Ford RB, et al. The 2006 American Associa-
leukemia virus and feline immunodeﬁciency virus in cats with abscesses or bite tion of Feline Practitioners Feline Vaccine Advisory Panel Report. JAVMA
wounds and rate of veterinarian compliance with current guidelines for retrovi- 2006;229:1405-1441.
OCTOBER 12–15, 2009
Atlantic City Convention Center
Atlantic Coast Veterinary Conference
Offering the best value in veterinary
continuing education — plus the excitement of Atlantic City!
Check out everything that's included in your registration fee:
• WORLD CLASS CE in a relaxed, smoke-free environment, • We provide over 330 hours of stimulating education in an
featuring more than 40 of the foremost veterinary speakers environment that emphasizes the entire veterinary team
across the United States • 23 RACE approved Continuing Education credits
• Breakfast and lunch included Tuesday, Wednesday & Thursday • Wet labs for veterinarians: Ultrasound, Rigid Endoscopy, Ear
• “Ask The Professor” Lunch Sessions Therapeutics, Stifle Procedures, Tibial Tuberosity Advancement,
• Proceedings on-line (pre-conference) and provided on CD-ROM and more!
(also available in printed version) • Wet labs for technicians: Animal Behavior, Canine CPR, Dental
• Access to over 200 of the leading suppliers of veterinary goods Radiography, Clinical Chemistry, Instrument Care, and more!
and services will be exhibited
Wet Lab Space is Limited!
Be sure to register early!
390 Amwell Road, Suite 403, Hillsborough, NJ 08844
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e email@example.com 273
In collaboration with the American College of Veterinary Surgeons
Laparoscopic and Laparoscopic-Assisted
Cryptorchidectomy in Dogs and Cats
❯❯ Philipp Mayhew, BVM&S, MRCVS, DACVS
Columbia River Veterinary Specialists
Abstract: There are many applications for laparoscopy in small animal surgery. A relatively simple
one is abdominal cryptorchid castration. Laparoscopic examination of the peritoneal cavity can both
aid in the diagnosis of abdominal cryptorchidism and allow treatment using either a totally laparo-
scopic or a laparoscopic-assisted technique. Minimally invasive cryptorchid castration obviates the
need for “open” celiotomy and may thereby reduce postoperative discomfort and wound-related
At a Glance complications in these patients.
uring embryonic development in Testicular tumors develop much more fre-
Disadvantages male dogs and cats, contraction of quently in cryptorchid testes than in scrotal
Page 275 the gubernaculum causes progres- testes. In one study, the risk of tumor devel-
Preoperative sive migration of the testes from a location opment in cryptorchid testes was 13.6 times
Assessment just caudal to the kidney to their normal the risk in scrotal testes.2 Inguinally retained
Page 275 position in the scrotum.1 This migration is testes appear to be at even higher risk of
Instrumentation typically complete by 2 months of age but developing neoplasia than abdominally
Page 276 can take place as late as 6 months of age in retained testes.3 The risk of testicular torsion
some breeds.1 The cause of cryptorchidism is also increased for cryptorchid testes, with
Page 278 has not been completely elucidated but is torsed testes often being neoplastic.4
likely multifactorial.1 Migration of the testis If, on physical examination, one or both
can cease at any time, with the result that testes are not present inguinally or scrotally,
one or both testes can remain in the perito- the missing testis is most likely within the
neal cavity, within the inguinal rings, or in peritoneal cavity. Palpation should be per-
the inguinal area cranial to formed carefully because cryptorchid testes
the scrotum. are often smaller than descended testes and
TO LEARN MORE Owners should be advised can be difﬁcult to ﬁnd. Traditionally, abdom-
that there are several impor- inal testes have been removed through either
tant reasons to castrate a a ventral midline celiotomy or a paraprepu-
cryptorchid pet. First, cryp- tial laparotomy.5 Totally laparoscopic or
For a description of CE Article #1
Cryptorchidism torchidism is thought to be a laparoscopic-assisted techniques now exist,
conventional surgical Stephen J. Birchard, DVM, MS, DACVS
Michael Nappier, DVM
The Ohio State University
approaches to cryptorchid
sex-linked autosomal recessive
ABSTRACT: Cryptorchidism is a common clinical problem in dogs and cats. Retained testes can
be unilateral or bilateral, are usually small and atrophied, and vary in location.These factors make
diagnosis and surgical removal challenging in some animals. Diagnosis is confirmed using a variety of
modalities, including diagnostic imaging in difficult cases. Surgical removal of the affected and normal
testes is the treatment of choice.The surgical approach and technique used depend on the location
allowing removal of intraabdominal testes
of the retained testis.
testes, see the June 2008 C
ryptorchidism is one of the most com-
mon congenital defects seen in small ani-
mal practice. In dogs, the reported
prevalence of cryptorchidism ranges from 0.8%
to 10%.1 The defect is a sex-linked autosomal
trait in dogs. Further breeding
recessive trait that is common in certain breeds,2
ficult in some animals. A thorough and systematic
approach to patient evaluation is necessary to effi-
ciently find and remove the abnormal testis.
Although surgery for removal of cryptorchid
testes is well described in the veterinary literature,
approaches to diagnosis and localization of ectopic
through much smaller incisions. Neoplastic
such as Chihuahuas, miniature schnauzers, testes have not been extensively described. This
Pomeranians, poodles, Shetland sheepdogs, and lack, coupled with the increasing number of ani-
could lead to propagation of cryptorchid testes can also be removed
Yorkshire terriers. Smaller breeds are 2.7 times mals that present with an unknown neutering his-
more likely to be cryptorchid than larger breeds.3 tory (e.g., rescue animals), emphasizes the need for
In cats, one study found Persians to be predis- a discussion of a thorough clinical approach to
posed to cryptorchidism.4 Due to the thermal cryptorchidism.
suppression of sperm production, bilaterally This article describes a systematic approach
cryptorchid animals are sterile, while unilaterally to the diagnosis and surgical treatment of cryp-
cryptorchid animals are usually fertile.5 Unde- torchidism in dogs and cats, including the inte-
scended testes are 13.6 times more likely to gration of the history; physical examination;
develop neoplasia (Figure 1) than normal testes blood tests, including hormone assays; and
this undesirable trait. Second, laparoscopically, although if the tumor is
and are at increased risk of torsion.6,7 diagnostic imaging to make a definitive
Undescended testes vary in their anatomic posi- anatomic diagnosis. Various options for surgical
tion. They may be located in the prescrotal area, removal of the retained testis are also described.
inguinal region, or abdominal cavity. In a study of
240 cryptorchid dogs and 50 DIAGNOSIS
cryptorchid cats, retained testes History
were most commonly found in Most authors agree that if one or both testes
• Take CE tests the right inguinal region in are not present in the scrotum by 2 months of
• See full-text articles dogs and in the left or right age, the animal is cryptorchid. 2 It is highly
inguinal region in cats.8 Locat- unlikely that the testes will descend into the
cryptorchid testes are prone very large, open surgery may remain more
ing an ectopic testis can be dif- scrotum after this age. The clinical signs of
June 2008 325 COMPENDIUM
to several pathologic states. practical.
274 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
A minimally invasive approach to abdomi- -
nal cryptorchid testis removal reduces tissue It is with great pleasure that I announce the new
trauma and is likely to reduce postoperative partnership of the American College of Veterinary
pain and wound healing complications com- - Surgeons (ACVS) with Compendium in the
pared with open laparotomy. If localization “Surgical Views” series. The expertise and experi-
ence of the ACVS Diplomates will add greatly to
of a cryptorchid testis is challenging, laparo- -
the value of the series.
scopic examination of the caudal peritoneal
Elizabeth M. Hardie, DVM, PhD, DACVS
cavity and the entrance to the inguinal rings
North Carolina State University
provides excellent visualization and can help to
rule out the diagnosis of abdominal cryptorchid-- The ACVS is proud to enter into this new coop-
ism. This may help to minimize iatrogenic dam- - erative venture with Compendium and series edi-
age to surrounding structures, which has been tor Elizabeth Hardie. The ACVS is well known as
attributed in some cases to inadequate visual- - a world leader in developing innovative surgical QuickNotes
ization when small paramedian laparotomies procedures and disease research, yet continuing
education is also one of the pillars of the College. Generally, a male
are performed. Such damage includes inad- -
vertent prostatectomy and ureteral or urethral
In addition to presenting at our yearly sympo- dog or cat in which
sium, ACVS Diplomates host and produce much one or both testes
trauma.6–8 of the continuing education in veterinary surgery
in the United States. Now, with this collaboration, are absent from
Disadvantages we are expanding our education outreach to a the scrotum at 6
The principal disadvantage of laparoscopy is the new venue. The ACVS hopes you will enjoy and months of age is
proﬁt from our Diplomates’ contributions to this
need for specialized equipment and the associ- - classiﬁed as cryp-
distinct continuing education effort.
ated costs. Adequate training is also necessary y torchid because
to perform laparoscopic procedures and to use Larry R. Bramlage, DVM, MS, DACVS
Chair, ACVS Board of Regents scrotal migration
the equipment appropriately. Although surgi- -
of a testis after this
cal time can initially be longer than that for an
open procedure, with experience, laparoscopic To locate a Diplomate, ACVS has an online directory that time is extremely
cryptorchidectomy is likely to become as efﬁ-
includes practice setting, species emphasis, and research
cient, if not faster than, its open counterpart.
Preoperative Assessment within the peritoneal cavity. This can be done
A careful history should be taken for any male by gentle manipulation of the scrotal testis in
cat or dog in which two testes cannot be pal- a cranial direction, which will usually reveal
pated in the inguinal area to ensure that one the side on which it is located.
or both testes have not been removed previ- If no inguinal testes are palpated, it can be
ously. Generally, a male dog or cat in which assumed that the missing testes are in either
one or both testes are absent from the scrotum the inguinal canal (which is uncommon) or the
at 6 months of age is classified as cryptorchid abdomen. Abdominal ultrasound
because scrotal migration of a testis after this can be used to conﬁrm the presence
time is extremely unlikely.1 It is important to of abdominal or inguinal canal testes SURGICAL
assess the inguinal area carefully with the in most cases. If doubt still remains VIDEO
animal under heavy sedation or general anes- about the presence or absence of tes-
thesia so as not to miss the presence of an tes, a human chorionic gonadotropin
To see a video of manipulation to
inguinal testis. If one testis is present scrotally stimulation test can be performed to identify which testis is cryptorchid,
and one abdominally, it is also helpful to iden- conﬁrm the presence of testicular tis- visit CompendiumVet.com.
tify whether the right or left testis is present sue.5 For this test, serum samples are
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 275
FIGURE 1 FIGURE 2
In many cases, the cryptorchid testis is
readily visible during initial visualization of the
peritoneal cavity. In this case, the testis can be
seen on the right side, lateral to the descending
colon and bladder.
Laparoscopic examination of the caudal
abdomen is a minimally invasive modality for
Port position for a totally laparoscopic approach for abdominal cryp-
conﬁrming the presence or absence of abdom-
torchidectomy in a dog. The subumbilical telescope port is placed first, followed inal testes, and laparoscopic or laparoscopic-
by two paramedian instrument ports. assisted techniques have been described for
removal of abdominally cryptorchid testes.
collected before and 2 hours after administra- Instrumentation
tion of human chorionic gonadotropin (50 IU/ As well as the basic components of an endo-
QuickNotes kg IM) and submitted for testosterone assay. scopic tower,10 other equipment required to
Unilateral or bilateral monorchidism is very perform laparoscopic and laparoscopic-assisted
Laparoscopic rare; therefore, it is most likely that abdomi- cryptorchidectomy includes a laparoscope, two
examination of the nal testes are present,7,9 making exploration of or three trocar–cannula assemblies, and lap-
caudal abdomen the peritoneal cavity a reasonable next step. aroscopic surgical instruments. The most com-
is a minimally Typically, exploration is accomplished via open monly used laparoscope size is 5 or 10 mm, and
surgery through a ventral midline celiotomy or the most common lens angles are 0° and 30°.
a paramedian laparotomy.5 In cats, a standard Trocar–cannula assemblies can be disposable or
ity for conﬁrming ventral midline laparotomy that must usually reusable and are usually 6 mm in diameter to
the presence or extend caudally to the pubis is performed. ﬁt 5-mm instrumentation. Typically, sterilizable,
absence of abdomi- reusable cannulas are more cost-effective than
nal testes. single-use devices for veterinary use.
TO LEARN MORE Instruments essential for laparoscopic cryp-
torchidectomy include a blunt probe for tissue
manipulation and Kelly or Babcock forceps
Basic laparoscopic equipment and the Hasson for grasping the testis, spermatic cord, and
and Veress needle techniques are described in gubernaculum. For hemostasis during totally
the August 2008 article, “Canine Laparoscopic laparoscopic cryptorchidectomy, either a ves-
and Laparoscopic-Assisted sel-sealing device (e.g., Ligasure [Valleylab Inc.,
Boulder, CO], Enseal [Ethicon Endosurgery,
Ovariectomy,” available at
Cincinnati, OH], Harmonic Scalpel [Ethicon
A video demonstrating
Endosurgery, Cincinnati, OH]) can be used.
the Hasson technique If these devices are not available, hemostasis
is also available at can be achieved using either hemostatic clips
CompendiumVet.com. dispensed by a laparoscopic clip applier or
extracorporeal suturing. A knot pusher is used
276 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
FIGURE 3 FIGURE 4
The spermatic cord and vascular pedicle of Only the gubernaculum (no vascular pedicle
the testis can be seen entering the inguinal ring or spermatic cord) can be seen entering the
in this dog. This finding confirms that the testis is inguinal ring in this dog. This confirms that the tes-
located extraperitoneally. tis is within the abdomen, and a thorough examina-
tion of the caudal peritoneal cavity should reveal
to place extracorporeal sutures. If a testicular
tumor is suspected, resection and placement
into a specimen retrieval bag before removal Once the telescope port has been established,
from the peritoneal cavity is advised to avoid an instrument port can be established using a 5-
port site metastasis. or 10-mm trocar–cannula assembly under direct
visualization in a paramedian location (lateral to
QuickNotes Surgical Techniques the prepuce in dogs; in the left or right caudal
Patient Preparation and Positioning quadrant of the abdomen in cats) on the right or
The possibility of Dogs and cats with cryptorchid testes should left side, depending on which testis is located in
conversion to an be positioned in dorsal recumbency on the the abdomen. Every effort should be made to
open approach surgical table. The inguinal area should be avoid iatrogenic damage to the caudal superﬁ-
should always be thoroughly palpated again to rule out an ingui- cial epigastric vessels during cannula placement.
anticipated with nally located testis and prevent unnecessary In most bilaterally cryptorchid animals, the side
laparotomy or laparoscopy. The entire ventral that the instrument port is placed on is not criti-
abdomen from the scrotum to the xiphoid pro- cal because both testes will still be retrievable
procedure. cess and laterally to the midabdominal level from the same port.9
should be aseptically prepared, as the possibil- A totally laparoscopic technique is usually
ity of conversion to an open approach should performed using a three-port technique. A
always be anticipated with any laparoscopic two-port technique can be used if an oper-
procedure. After initiating the pneumoperito- ating laparoscope with a working channel is
neum, place the animal in a 20° to 30° “head used. A camera port should be placed in a sub-
down” (Trendelenburg) position to allow cau- umbilical position. Two more instrument ports
dal peritoneal organs to move cranially, thus are established in paramedian (lateral to the
improving visualization of the area. In some prepuce) positions on both sides of the pre-
cases, it may also be beneﬁcial to tilt puce in dogs (FIGURE 1) and in a triangulating
the animal laterally to better visualize position around the caudal abdomen in cats.
SURGICAL one or both testes.
VIDEO Exploration of the Caudal Peritoneal Cavity
Port Position In many cases, after establishment of a pneumo-
Laparoscopic-assisted cryptorchidectomy peritoneum, the abdominal testis can be seen
To see a video of the use of a can be performed using a two-port tech- immediately on entering the peritoneal cavity
vessel-sealing device to seal nique. A telescope port is established in with the laparoscope (FIGURE 2). However, if
and section the gubernaculum,
a subumbilical location, using either the confusion exists, the area of the internal ingui-
spermatic cord, and vascular
Hasson technique or a Veress needle tech- nal ring should be visualized. If the spermatic
CompendiumVet.com. nique. These techniques were described cord and vascular pedicle of the testis are seen
in an earlier Surgical Views article.10 entering the ring, the testis is in an extraperito-
278 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
neal location, either within the inguinal canal testis from the peritoneal cavity. Once the tes-
or (more likely) in an inguinal location (FIGURE tis has been exteriorized, clamp and double
3). The surgeon should reevaluate the ingui- ligate the spermatic cord and vascular pedicle
nal area if no testis was palpated in that loca- before sectioning. It is important to ensure that
tion previously. If only the gubernaculum is ligated pedicles are not bleeding and do not
seen entering the inguinal ring, the testis is become caught in the subcutaneous fat or
located within the peritoneal cavity, and fur- muscular tissue of the body wall as they are
ther inspection of the caudal abdomen usually returned to the peritoneal cavity.
locates it. Gentle traction can also be placed If both testes are in the peritoneal cavity,
on the gubernaculum to help in localization they can usually be recovered through the
(FIGURE 4). In some cases, the testis is obscured same port incision. To locate the second tes-
by the bladder or other surrounding structures. tis, reestablish the pneumoperitoneum. If the
instrument port was enlarged to recover the
Laparoscopic-Assisted Cryptorchidectomy ﬁrst testis, use a larger cannula, hold a moist-
The laparoscopic-assisted cryptorchidectomy ened sponge around the cannula, or place
technique provides a rapid, simple way to a temporary purse-string suture around the
recover an abdominal testis and ligate the vas- cannula to prevent leakage of carbon dioxide
cular pedicle and spermatic cord outside the during reinsertion of the cannula. The second
abdominal cavity, thereby obviating the need testis can then be withdrawn and ligated in
for intracorporeal ligation techniques.9 In this the same manner as the ﬁrst. If the second tes-
technique, laparoscopic Kelly or Babcock for- tis cannot be advanced to the port site, estab-
ceps are placed through the instrument port lish a third port on the opposite side of the QuickNotes
to grasp the testis or the spermatic cord. At prepuce (FIGURE 1) and follow the above steps
this point, it is helpful to evacuate the pneu- to withdraw the second testis, although in my If both testes are
moperitoneum to decrease tension during experience, this is unlikely to be necessary. in the peritoneal
elevation of the testis. Enlarge the port inci- The port site incision(s) should then be closed, cavity, they can usu-
sion by separating the parallel ﬁbers of the making sure that the ventral sheath of the rec- ally be recovered
rectus abdominus just enough to remove the tus abdominus is adequately sutured to prevent through the same
herniation of abdominal contents, which can
occur through defects as small as 5 mm. After
closure of the instrument port incisions and
Clinical Pearls before closure of the telescope port, it is advis-
able to brieﬂy reestablish the pneumoperito-
neum and reinsert the telescope to ensure that
Laparoscopic examination of the caudal
peritoneal cavity can be very helpful in good hemostasis has been maintained. Finally,
localizing cryptorchid testes and can remove the telescope, thoroughly purge the
prevent an unnecessary celiotomy. pneumoperitoneum from the peritoneal cavity,
and close the telescope portal routinely.
cryptorchidectomy is a simple, rapid Totally Laparoscopic Cryptorchidectomy
technique that does not require In the totally laparoscopic cryptorchidectomy
specialized equipment beyond the basic technique, the vascular supply and spermatic
cord are ligated within the peritoneal cavity
In many cases, neoplastic cryp- before the testis is removed from the abdomen.
torchid testes can be removed using If the testis is directly visible, it can be grasped
a laparoscopic technique. If the testis with laparoscopic Kelly or Babcock forceps
is ≥8 cm in diameter or has signiﬁcant and elevated (FIGURE 5), allowing the vascular
adhesions to surrounding structures, pedicle and spermatic cord to be moved away
it may be more practical to perform a from surrounding structures in readiness for
ventral midline celiotomy. ligation. A vessel-sealing device can be placed
into the second instrument port, and the guber-
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 279
FIGURE 5 FIGURE 6
The testis is elevated for totally laparo- The vascular pedicle after sectioning using
scopic cryptorchidectomy to allow better the vessel-sealing device. The pedicle has been
access to the vascular pedicle and spermatic cord sealed in two different locations approximately 1 cm
during intracorporeal ligation of these structures. apart to ensure good hemostasis.
naculum, spermatic cord, and vascular pedicle disposable equipment), it is likely to be the
sealed and subsequently sectioned. most time-consuming because these sutures
The vascular pedicle can be substantial in are tedious to place; however, a rapid learn-
large dogs, and care should be taken to ensure ing curve has been seen in studies that used
adequate hemostasis. The Ligasure and Enseal extracorporeal suturing.12
devices are both indicated to seal vessels up to When laparoscopic cryptorchidectomy is
7 mm in diameter, and I have used them to seal performed, the testis must be withdrawn
the pampiniform plexus effectively. However, it through one of the ports. One of the para-
QuickNotes is suggested that the vascular pedicle be double preputial ports can be used for this purpose,
The vascular pedicle sealed—once proximally and once distally— or the telescope can be replaced into one of
before sectioning (FIGURE 6). If a vessel-seal- the instrument ports and the testis withdrawn
can be substantial
ing device is not available, hemostasis can be through the subumbilical port. If the subumbili-
in large dogs, and achieved using hemostatic clips delivered via a cal port is used, any enlargement of the port
care should be laparoscopic clip applier. Although 5-mm lap- incision will be through the linea alba, resulting
taken to ensure ade- aroscopic clip appliers are available, medium in less muscular trauma and therefore possibly
quate hemostasis. or large clips are generally delivered in a less postoperative pain than if a paramedian
10-mm clip applier. To reduce costs associated instrument port is enlarged. After laparoscopic
with the use of expensive single-use dispos- cryptorchidectomy, it is not necessary to rees-
able clip appliers, multiﬁre sterilizable clip tablish the pneumoperitoneum because the
appliers that can be loaded with cartridges of pedicles are inspected for hemostasis immedi-
clips are available (M/L-10, Microline Pentax, ately after they have been sealed or ligated and
Beverly, MA). sectioned. After the testis has been removed, all
Another alternative for achieving hemostasis remaining ports can be closed routinely.
of the pedicle is the placement of extracorpo-
real ligatures. To place extracorporeal sutures, Resection of Neoplastic or Torsed
pass a piece of suture material through Cryptorchid Testes
one cannula and around the pedicles. Cryptorchid testes are predisposed to neopla-
SURGICAL Withdraw the suture through the same sia and torsion, both of which are indications
VIDEO cannula, tie a modiﬁed Roeder knot for surgical excision.1–4 Whether a laparoscopic
outside the peritoneal cavity, push the approach is feasible in these situations depends
knot into place through the cannula, on several variables. If the testis is very large
To see a video of testis and tighten it around the pedicle using (8 to 10 cm), a laparoscopic approach may be
removal through the
a laparoscopic knot pusher.11 Although less practical because a large incision will be
subumbilical port, visit
CompendiumVet.com. this is the least expensive technique required to retrieve the testis after its pedicles
(it does not require any expensive have been ligated. A second potential problem
280 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
is the presence of adhesions to other struc- literature.13 In my experience, most neoplastic
tures, speciﬁcally the bladder, ureters, prostate, abdominally cryptorchid testes remain small
and lower gastrointestinal tract. If the surgeon and mobile enough to be resected laparoscopi-
has any concern about the involvement of cally in a manner similar to those described
these structures or encounters technical difﬁ- above for removal of nonneoplastic testes. If
culties while dissecting adhesions, conversion a testis is suspected to be neoplastic, it should
to an open approach should be considered. be placed in a specimen retrieval bag before
However, laparoscopic resection of a neoplas- being pulled through the instrument port to
tic testis has been reported in the veterinary reduce the possibility of port-site metastasis.
1. Romagnoli SE. Canine cryptorchidism. Vet Clin North Am Small my as a complication of cryptorchidectomy in four dogs. JAAHA
Anim Pract 1991;21:533-544. 1996;32:211-214.
2. Hayes HM, Pendergrass TW. Canine testicular tumors: epide- 9. Miller NA, Van Lue SJ, Rawlings CA. Use of laparoscopic-as-
miological features of 410 dogs. Int J Cancer 1976;18:482-487. sisted cryptorchidectomy in dogs and cats. JAVMA 2004;224:875-
3. Reif JS, Maguire TG, Kenney RM, et al. A cohort study of canine 878.
testicular neoplasia. JAVMA 1979;175:719-723. 10. Gower S, Mayhew PD. Canine laparoscopic and laparoscopic-
4. Pearson H, Kelly DF. Testicular torsion in the dog: a review of 13 assisted ovariohysterectomy and ovariectomy. Compend Contin
cases. Vet Rec 1975;97:200-204. Educ Pract Vet 2008;30:430-440.
5. Birchard SJ, Nappier M. Cryptorchidism. Compend Contin 11. Stoloff DR. Laparoscopic suturing and knot tying techniques.
Educ Pract Vet 2008;30:325-336. In: Freeman LJ, ed. Veterinary Endosurgery. St. Louis: Mosby;
6. Bellah JR, Spencer CP, Salmeri KR. Hemiprostatic urethral avul- 1999:85.
sion during cryptorchid orchiectomy in a dog. JAAHA 1989;25:553- 12. Mayhew PD, Brown DC. Comparison of three techniques for
556. ovarian pedicle hemostasis during laparoscopic-assisted ovari-
7. Millis DL, Hauptman JG, Johnson CA. Cryptorchidism and ohysterectomy. Vet Surg 2007;36:541-547.
monorchidism in cats: 25 cases (1980-1989). JAVMA 1992;200: 13. Pena FJ, Anel L, Dominguez JC, et al. Laparoscopic surgery
1128-1130. in a clinical case of seminoma in a cryptorchid dog. Vet Rec
8. Schultz KS, Waldron DR, Smith MM. Inadvertant prostatecto- 1998;142:671-672.
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June 2009 | Compendium: Continuing Education for Veterinarians® 281
Primary Kitten Vaccine Series5
Vaccine Initial Dosea Booster Intervals Considerations
Feline panleukopenia As early as 6 weeks of age Every 3 to 4 weeks
Feline herpesvirus-1 As early as 6 weeks of age Every 3 to 4 weeks
Feline calicivirus As early as 6 weeks of age Every 3 to 4 weeks
Rabies As early as 8 weeks of age Single dose in the first year;
or 12 to 16 weeks of age follow state or local statutes
Feline leukemia virus As early as 8 weeks One booster 3 to 4 Kittens should test negative
(FeLV) of age weeks later for FeLV before vaccination
aDepends on the vaccine.
adjuvants. The canarypox-vectored a few weeks. However, a lump that 2006, pp. 1069–1119.
recombinant vaccines, for example, persists or grows can be a sign of VAS. 3. Dawson S, Willoughby K, Gaskell R, et al: A
field trial to assess the effect of vaccination
stimulate protective immunity and Although the risk of VAS is relatively against feline herpesvirus, feline calicivirus and
reduce the potential risks associated low (approximately one to two cases per feline panleukopenia virus in 6-week-old kit-
tens. J Feline Med Surg 3:17–21, 2001.
with an adjuvant. 10,000 vaccinated cats 8,9), the probability 4. Reese MJ, Patterson EV, Tucker SJ, et al: The
Another way to potentially reduce that a kitten will be exposed to a effect of anesthesia and surgery on serological
responses to vaccination in kittens. JAVMA
inflammation at the injection site is with potentially fatal disease is considerably 233(1):116–121, 2008.
the needle-free VET JET® transdermal higher.10 5. AAFP Advisory Panel: The 2006 American
delivery system. Compared with Still, vaccines are important, even for Association of Feline Practitioners Feline
Vaccine Advisory Panel Report. JAVMA
conventional needles and syringes, this indoor kittens. “It’s possible for owners 9(1):1405–1441, 2006.
system disperses a smaller volume of to track the panleukopenia virus into the 6. Hoover EA, Olsen RG, Hardy WD Jr, et al: Feline
leukemia virus infection: Age-related variation in
vaccine (0.25 ml) into the tissue through house,” according to Dr. Wolf, “and response of cats to experimental infection. J Natl
a tiny orifice (about the diameter of a 36- while less likely, owners can bring Cancer Inst 57:365–369, 1976.
gauge needle). respiratory viruses home on their 7. Macy DW, Hendrick MJ: The potential role of
inflammation in the development of postvacci-
clothing.”11 Kittens may also be exposed nal sarcomas in cats. Vet Clin North Am 26(1):
Discussing Vaccine Issues to sick cats through porch screens or 103–108, 1996.
with Clients when boarded, groomed, or traveling 8. Kass PH, Barnes WG Jr, Spangler WL, et al:
Epidemiologic evidence for a causal relation
Owners should be instructed to monitor with their owners. “Certainly, all kittens between fibrosarcoma and tumorgenesis in
their kittens for signs of possible vaccine need to receive their core vaccines,” says cats. JAVMA 203:396–405, 1993.
9. Esplin DG, McGill LD, Meininger AC, et al:
reactions. “The most common reaction Dr. Wolf. Postvaccination sarcomas in cats. JAVMA
is a mild malaise or fever that may last 202:1245–1247, 1993.
for 24 hours,” explains Dr. Wolf. “That’s REFERENCES 10. Tizard IR: The uses of vaccines, in Veterinary
1. Richards J, Rodan I: Feline vaccination guide- Immunology: An Introduction, St. Louis, Saun-
simply the immune system responding lines. Vet Clin North Am Small Anim Pract ders Elsevier, 2009, pp. 270−285.
to the vaccine.” (31)3:455−472, 2001. 11. Gaskell RM, Dawson S, Radford A: Feline respira-
2. Greene CE, Schultz RD: Immunophylaxis, in tory disease, in Greene CE (ed): Infectious Dis-
Mild swelling at the vaccine site may Greene CE (ed): Infectious Diseases of the Dog eases of the Dog and Cat, ed. 3. St. Louis,
also occur and generally resolves within and Cat, ed. 3. St. Louis, Saunders Elsevier, Saunders Elsevier, 2006, pp. 145−154.
This information has not been peer reviewed and does not necessarily reflect the opinions of, nor constitute or imply endorsement or
recommendation by, the Publisher or Editorial Board. The Publisher is not responsible for any data, opinions, or statements provided herein.
CREDITS CE Article 1
Courtesy of Carol Adams, Lone Oak Veterinary Clinic
Clinical Recognition and Management
❯❯ Debra L. Zoran, DVM, MS, Abstract: Obesity is one of the most common clinical problems in cats presenting to veterinary
PhD, DACVIMa practitioners. Because it is a risk factor for other conditions, such as diabetes mellitus and hepatic
Texas A&M University
lipidosis, it not only increases the morbidity of affected cats but may also shorten their life span. In
cats, a body weight of greater than 20% over the ideal weight of the animal is generally accepted
as obese. The goal of this article is to help all members of the health care team understand how to
prevent the development of obesity in young cats and, when confronted with an obese adult cat,
how to develop a safe and effective weight-loss program.
At a Glance epending on the study cited, the
number of obese or overweight The commonly stated reason for devel-
Preventing Obesity cats in Western societies ranges opment of obesity is that an animal
Page 284 from 15% to 35%, with practitioners estimat- is consuming more energy than it is
Steps in a Weight-Loss ing even higher numbers in some areas.1–5 expending.12 This energy imbalance can
Program for an Obese Cat A body weight of greater than 20% over be due to excessive dietary intake of calo-
Page 286 the ideal weight of the animal is generally ries or a reduction in energy expenditure.
Clinical Evaluation accepted as obese for cats, which means However, obesity is not just a simple mat-
of Obese Cats that a 4-kg (9-lb) cat that gains 1 kg (2 lb) is ter of intake or output. Many other fac-
Page 287 considered obese. Obesity in cats not only tors that can inﬂuence or control appetite,
Methods of Assessing is a cosmetic problem but also increases metabolism, and homeostasis, including
Body Condition the risk of development of diabetes6 and genetic predisposition, sex, neuter status,
Page 288 hepatic lipidosis7 and is associated with and hormonal disturbances, may play sig-
increased incidences of many other condi- niﬁcant roles in the development of obe-
Obesity and Diet
Page 289 tions, such as lower urinary tract disease sity.5,8,12 As a result, it is important to make
and osteoarthritis.8 Presuming that obesity a concentrated effort to recognize risk fac-
Creating a Treatment Plan in cats is similar to that in dogs and humans, tors, monitor young and middle-aged cats
this condition will also shorten the life carefully to detect excess weight gain early,
span of affected cats.8–11 Considering the promote the importance of obesity pre-
number of cats already affected and the vention and the health beneﬁts of weight
great difﬁculty in getting a 12-kg (25-lb) cat control from the ﬁrst veterinary visit, and
Dr. Zoran discloses that she has
to weigh 4.5 kg (10 lb) again, it is clear that be actively involved in body assessment
received ﬁnancial support from
Nestlé Purina Petcare and Pﬁzer the situation demands veterinarians’ full (weight and body condition score [BCS])
Animal Health. attention. of all cats at every visit. In other words,
284 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
Feline Obesity CE
obesity prevention must start early, and the Even when owners measure the amount of
veterinary team is essential to recognition, food they give their cats, feeding recommen-
early intervention, and success. dations based on the label recommendations
There is now ample evidence that neutering for a particular food or traditional maintenance
is an important risk factor for obesity in male energy calculations are likely to result in sig-
and female cats.13–19 For some time, it has been niﬁcant overfeeding. These recommendations
recognized that many cats have signiﬁcant are based on feeding trials in intact, young,
weight gain after neutering or during their ado- active cats—not neutered, indoor (sedentary)
lescent years, but most clinicians believed this cats—and as a result, they are approximately
was due entirely to the type or amount of food 30% higher than most housecats need. While
fed. However, several recent studies13–18 have the appropriate number of calories proposed
shown that multiple hormonal changes that sig- in the veterinary literature for the maintenance
niﬁcantly affect feline metabolism immediately energy requirement in cats ranges from 20 to
follow removal of the gonads.a These changes 100 kcal metabolizable energy (ME)/kg/day,
affect food intake and energy metabolism and multiple papers have suggested that 70(BWkg)0.75
result in an increase in body fat mass that is represents the resting energy requirement and
almost inevitable unless appropriate measures 94 to 125(BWkg)0.75 the accepted range for the
to limit intake are taken immediately.14–19 maintenance energy requirement for cats.
However, in 2006, the National Research
Controlling Food Intake Council recommended maintenance amounts
Because gonadectomy is now recognized as a of 130(BWkg)0.40 for obese cats and 100(BW)0.67
risk factor for obesity,13–18 the key factor for pre- for lean cats,21 and several recent studies of neu-
vention of obesity in neutered animals appears tered cats have shown that feeding cats typical
to be careful control of intake immediately after maintenance amounts of food results in weight QuickNotes
neutering (e.g., no free-choice feeding) and and (more importantly) fat mass gain.22 Kienzle
close monitoring of body weight and BCS to and colleagues23 analyzed the caloric needs in Obesity is a com-
allow adjustments in intake if needed.14,16,18 As a mon, serious medi-
rule of thumb, intake recommendations based cal problem in cats.
on commercial food labels should be reduced Free-Choice Feeding and
by 30% for neutered animals to account for the
hormonal changes resulting in reduced energy Feline Health
needs.14,16,18 Several studies have evaluated the
role of different amounts of dietary components Free-choice feeding of dry food affects
(e.g., fat, carbohydrates) in the development of overall feline health in many ways, including:
obesity after neutering, but the key factors that Inadequate water intake, which can lead to an
result in increase in body weight are gonadec- increased risk of constipation and urolithsa,b
tomy and free-choice access to food.17,19 Free-
Learned preference for dry food, which
choice access to dry food is not an appropriate
may make it difﬁcult to change to a
method of feeding for many cats—particularly
therapeutic canned dietc
indoor, neutered, inactive cats—for many rea-
sons (BOX 1). The most important with regard to Inability of owners to monitor the amount
obesity is the risk of overfeeding (or overeating), of food being eaten, which may lead them
which even in very small amounts can exceed to miss subtle signs of illnessd
appropriate caloric intake and result in weight
gain. Further, due to the feline preference (and, a
Seefeldt SL, Chapman TE. Body content and turnover in cats fed
dry and canned rations. Am J Vet Res 1979;40:183-185.
when eating small meals such as mice, physi- b
Finco DR, Adams DD, Crowell WA, et al. Food and water intake
ologic need) for eating multiple meals a day, it and urine composition in cats: inﬂuence of continuous versus
is best to provide cats’ caloric requirements in periodic feeding. Am J Vet Res 1986;47:1638-1642.
two to four meals/day. 20 Horowitz D, Soulard Y, Junien-Castagna A. The feeding behavior
of the cat. In: Pibot P, Biourge V, Elliott D, eds. Encyclopedia
of Feline Clinical Nutrition. Aniwa SAS, Aimargues, France;
For an overview of some of the metabolic changes related d
Houpt KA. Feeding and drinking behavior problems. Vet Clin
to obesity, see the companion article on CompendiumVet. North Am Small Anim Pract 1991;21:281-298.
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 285
CE Feline Obesity
colony cats and reported that neutered females for cats—one that will be extremely difﬁcult to
required 100(BW kg ) 0.40 and neutered males achieve in cats being fed a calorie-dense (high-
required 120(BWkg ) 0.40 to maintain ideal body fat) food or allowed free access to dry food.
condition. In two other feeding studies,24,b inves-
tigators determined that neutered cats consum- Increasing Exercise
ing more than 50 to 60(BWkg)0.67 gained weight Like many people, indoor cats are sedentary,
and underwent a change in BCS from ideal to which has detrimental effects on their physiologic
obese in just 3 months. and psychologic health and well-being. Therefore,
In simple terms, an intake of 30% less than increasing activity and energy expenditure are
maintenance requirements means that most very important aspects of weight management
average-sized, indoor, neutered cats weighing in indoor cats. However, it is not easy to induce
4 to 5 kg (9 to 11 lb) need to eat less than 200 cats to exercise. Lifestyle alteration is, then, one
kcal/day, and many may need even less than of the most important additions to any program
180 kcal/day to maintain lean body condition of obesity prevention or management.25
(BOX 2). This is a signiﬁcantly smaller amount of Exercise is a key factor in health for several
food than is often recommended and represents reasons: (1) it helps maintain and strengthen
a critical change in feeding recommendations lean muscle tissues, (2) it promotes cardiovas-
cular health, (3) it provides mental stimula-
Bauer JE. Texas A&M University. Personal communication. tion and improves overall quality of life, (4)
Indoor, neutered 2009. it increases energy expenditure and fat oxida-
cats are at greatest
risk of becoming
obese if their intake Steps in a Weight-Loss Program for an Obese Cat19,23,38,a
is not carefully lim-
ited soon after they 1. Determine ideal body weight: Set a If the cat is considered to be 60% above its
achieve adult size. target goal for weight loss. ideal weight, the ideal BW would be 6.25 kg
A record of the cat’s ideal weight at an (13.75 lb).
earlier age is the most accurate guide.
2. Determine the amount to feed: Energy
If you have no previous record of ideal allocation.
weight, you must estimate an ideal from
the current weight. This can be done by If possible, determine how much the cat is
using the body condition score (BCS): currently consuming. This may be difﬁcult
On a 9-point scale, each point above a 5 if the cat is being fed free-choice or lives
represents a 10% to 15% increase in in a multicat household without careful
body weight (BW). observation of intake.
Using this approach, a cat weighing If the amount is known, an intake reduction
10 kg (22 lb) and having a BCS of 9/9 of 20% to 40% from the calculated
is 40% to 60% above its ideal weight. maintenance requirements for a cat of ideal
Using an equation with both BW and body condition is a good starting point for
the percentage over BCS can provide an weight loss. The diet fed should contain
estimate of ideal BW: >45% metabolizable energy of protein and
be low in fat.
100% (normal BCS)
Ideal BW = × current weight The current National Research Council
100% + % above normal BCS
recommendations for maintenance require-
ments in lean and obese cats are as follows:
If the cat is considered to be 40% above its Lean cat: 100 kcal(BW)0.67 or 60 kcal/kg/
ideal weight, the ideal BW is calculated as day. For a 4-kg cat, this equals 240 kcal/day
follows: (4 kg × 60 kcal/kg/day = 240 kcal/day). Note
100% that many indoor, neutered cats, even if they
× 10 kg = 7.1 kg (15 lb) are lean, need 20% to 30% less than this
amount, or less than 200 kcal/day.
286 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
Feline Obesity CE
tion, and (5) it increases the metabolic rate.26 If for indoor cats to increase their muscle mass
feasible, protected outdoor activity should be and reduce their risk of obesity.
encouraged, as it is a great stimulus for play or
exercise activity. Cats that are unable to engage Clinical Evaluation of Obese Cats
in outdoor hunting or play behavior need other The ﬁrst step in identifying and correcting obe-
opportunities to fulﬁll their physiologic needs sity is recognizing it. Obviously, it is not difﬁ-
for climbing, balancing, scratching, and exer- cult to recognize a severely obese animal, but
cise.25,27,28 These requirements can be met in the veterinarian’s goal is to recognize changes
many ways and can be tailored to the cat and in body weight and condition early so that cor-
its situation. Toys may work well for some cats, rections in diet, intake, and exercise can be ini-
cat trees or play stations are excellent for oth- tiated to prevent progression to obesity, with
ers, and some cats respond well to interactive all of its associated hormonal changes and
toys that reward them with food. Clients do comorbid conditions.
not need to turn mice loose in their house to For assessment purposes, body composition
encourage activity or play, but they do have to is typically separated into fat mass and fat-free
engage their cats to create play opportunities. mass (FFM). The FFM is the largest, heaviest
The most important message about exercise portion and includes protein (muscle mass),
that veterinarians should give cat owners is minerals (bones), and water (intracellular and
that play and activity are essential components extracellular). Measuring or assessing the FFM QuickNotes
of a healthy feline lifestyle and are necessary provides essential information about an animal’s
Play and activity are
nents of a healthy
and are necessary
Obese cat: 130 kcal(BW)0.40 or 37 kcal/kg/ are essential to continued success. for indoor cats
day. For an 8-kg cat, this equals 296 kcal/ Adjustments in the weight-loss program are to increase their
day (8 kg × 37 kcal/kg/day = 296 kcal/day). based on results. If the cat is not losing weight muscle mass and
However, to achieve weight loss in an at a rate of 1% per week, the amount of food reduce their risk of
obese cat, its intake must be decreased intake should be decreased by 5% to 10%.
to 60% of the maintenance requirements: obesity.
Weight loss should be monitored frequently
0.60 × 296 = 178 kcal/day. In practice, this (every 2 to 4 weeks) and, to avoid discrep-
can be rounded up to 180 kcal/day. ancies, always using the same scale.
Some obese cats may need to consume Other recommended monitoring tools in-
as little as 20 to 30 kcal/kg/day to achieve clude BCS, morphometric measurements,
weight loss. This amount of food is very and photographs.
small, and the greatest concern is to
maintain adequate protein intake. As with any chronic disease, weight
management requires a good veterinarian–
client–patient relationship to achieve
3. Monitor the weight-loss program and optimal care and results.
make adjustments. It may be helpful to give owners an
The goal of weight loss is 1% to 2% of estimated time line for weight loss so
BW per week. At this rate, the cat is less that they have realistic expectations for
likely to lose lean muscle mass or develop results. In general, for a cat to have a 30%
hepatic lipidosis. decrease in BW, it takes approximately
Typically, cats lose weight more quickly at 12 months if the cat is losing 0.5%/week,
the start of the program, but metabolic and 7 months if the cat is losing 1%/week,
physiologic responses to weight loss result or 4 months if the cat is losing 2%/week.
in signiﬁcant slowing or even cessation of a
Hashimoto M, Funaba M, Abe M, et al. Dietary protein levels affect
weight loss over a short period of time. Thus, water intake and urinary excretion of magnesium and phosphorus,
monitoring progress and making adjustments in laboratory cats. Exp Anim 1995;44:29-35.
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 287
CE Feline Obesity
metabolic and physiologic status.29 Cats in thin be performed on an awake cat. They include
body condition with loss of muscle mass are BCS, morphometric measurements, and body
known to have higher morbidity and mortality mass index (BMI).29 Tools used in clinical or
and should be evaluated to determine the cause basic research also exist; detailed informa-
of the loss.30 By contrast, obesity is the accumu- tion on these techniques has been published
lation of body fat or an increase in the fat mass. elsewhere.8,29,31
In most cats, obesity represents an increase in
fat mass that causes increases in body weight Body Condition Scoring
and changes in body composition. BCS is perhaps the most widely accepted and
Measurement of body weight is the simplest well-known technique for assessing increased
technique for determining increased fat mass. fat mass.31–33 The two most common scoring
However, there are two main concerns with systems are the 5-point system (in which a
using only body weight monitoring: (1) mea- score of 3 is ideal) and the 9-point system
surement of body weight alone does not dis- (in which 5 is considered ideal).8,32 However,
tinguish the loss of FFM from the loss of fat because half points are often used in the
mass, and (2) scales are notoriously inaccurate 5-point system, resulting in a total of 9 catego-
or variable—measurements made on different ries, the systems are essentially identical, and
scales can vary signiﬁcantly. When weighing clinical use is based on preference.
cats, it is important to use a reliable, well- One disadvantage of using BCS to assess
maintained scale intended for small animals fat mass is that physical palpation cannot dis-
(pediatric scales are excellent) and to use the tinguish loss of FFM from gain of fat mass. So
same scale for all weight tracking to minimize although BCS can provide a subjective assess-
variability and maximize accuracy. However, to ment of an increase or decrease in fat mass in
QuickNotes better assess body condition, most nutritionists obese patients, it is not helpful in overall body
recommend that techniques for speciﬁc assess- condition assessment of FFM. For example, a cat
Clinicians should ment of fat mass be incorporated in the physi- with diabetes may be obese but have also lost
familiarize them- cal examination in addition to measuring body muscle mass due to the lack of insulin result-
selves with at least weight. In general, the techniques available to ing in muscle wasting. Simple assessment of BCS
one of the clinical clinical practitioners (BOX 3) are easy to use, by palpation cannot accurately distinguish these
techniques for require no special instrumentation, and can changes. Another disadvantage of BCS is its
assessment of body lack of repeatability in inexperienced observ-
BOX 3 ers. However, for estimating body fat mass in
use it daily. Methods of Assessing Body a clinical setting, BCS is an important tool. It
provides owners with tangible information
Condition8 about their pets and, when used repeatedly so
that familiarity and comfort are achieved, can
Clinically useful methods provide highly reproducible results.8,32,33
Serial body weight
Morphometry and Body Mass Index
Body condition score
Morphometric measurements and determina-
Morphometric measurements tion of BMI are also easy to use in a clinical
Bioelectric impedance setting; however, they are less well known and
Body mass index require more time. Morphometric analysis uses
Research methods measured parameters to provide an estimate of
Dual energy x-ray absorptiometry (DEXA) body composition. The simplest measurements
are dimensional evaluations, whereby a tape
measure is used to obtain speciﬁc dimensions
Ultrasonography, computed tomography, of the animal. In general, length measurements
or magnetic resonance imaging
of the head, thorax, and limbs correlate well
Electrical conductance with lean body mass,34 while circumference
Chemical analysis measurements (truncal/ribcage) correlate with
Neutron activation analysis fat mass.35 By using a measurement of lean
body mass (leg index) with a measurement of
288 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
Feline Obesity CE
fat mass (ribcage circumference) in the follow- acids and fatty acids that they are unable to
ing equation, BMI can be predicted28: synthesize from other food sources as omnivo-
rous species do.38 The
1.5 (ribcage circumference [cm] – leg index measurement [cm]) most commonly used
Feline BMI (% fat) =
9 foods for cats are dry,
extruded diets. These
In this equation, the ribcage circumference is foods meet the minimum requirements of the
measured at the ninth cranial rib, and the leg National Research Council and are nutritionally
index is the distance from the patella to the complete and balanced, readily available, easy
calcaneal tuber of one hindlimb.36 to use and store, and quite palatable. However,
Other morphometric measurements of body they bear little resemblance to a diet of a natu-
composition use speciﬁc tools to assess fat ral carnivore. Therefore, the distinctive nutri-
composition, such as ultrasonography (this ent requirements of cats should be taken into
technique has not been validated in cats) or account when designing a weight-loss or main-
bioelectric impedance analysis (BIA). In BIA, tenance diet.
the conductance of an applied electric current
in the patient is measured and used to calculate Protein
body composition.29,35,37 Because body ﬂuids As obligate carnivores, cats use protein as an
and electrolytes are responsible for the highest energy source even when other energy sources QuickNotes
conductance and adipose tissue is dehydrated, such as fat or carbohydrates are available.38
increased adipose tissue results in lower con- However, most researchers have focused on
ductance and greater impedance.29 Although fat and carbohydrate energy sources as having loss in cats requires
several BIA systems exist, none are widely the primary roles in the prevention and man- preservation of lean
available, and there are few reports of their agement of obesity. While it is critically impor- muscle tissue and
use in cats. BIA can be affected by electrode tant to reduce caloric intake in cats to achieve concurrent loss of
position, hydration status, consumption of food successful weight loss, this approach has over- fat mass, which is
or water, physical activity, conductance of the looked the important role of protein in feline best achieved using
examination table, and other variables.37 Thus, metabolism. Hoenig and colleagues39 showed
further evaluation of this technique is needed that cats consuming high-protein diets (>45%
before it can be recommended for routine use ME) had increased energy metabolism, higher
in the assessment of fat mass in cats. fat oxidation, and improved glucose tolerance, diets.
*** while cats consuming high-carbohydrate diets
Clinicians should familiarize themselves with had lower energy metabolism, required fewer
at least one of the clinical techniques for assess- calories to meet their needs, and gained fat
ment of body composition and use it daily so mass. Others40–43 have also shown that in obese
that it becomes not only a normal part of every cats, diets containing high levels of protein
physical examination but also a more reliable result in greater loss of fat mass and improved
and repeatable tool for assessing fat mass. preservation of muscle mass. This is important
Routine use of BCS also shows clients that their because muscle mass is a major determinant
veterinarian considers body condition assess- of metabolism. Muscle mass loss provokes a
ment to be an important part of their cat’s “starvation” response as the body seeks to pre-
physical examination and health evaluation. serve itself either through energy metabolism
Perception is reality: owners need to know that changes or increased intake. Therefore, loss of
obesity is important not only from what veteri- muscle mass increases the likelihood of weight
narians say but also from what we do. regain, and, particularly in cats, maintaining
muscle mass may be a key to successful weight
Obesity and Diet loss.44 Research has shown that even cats con-
Diet must be considered in any prevention or suming protein at 45% ME lost some muscle
treatment plan for feline obesity. Unlike most mass during diet restriction. This ﬁnding sug-
domestic species, cats are true carnivores. They gests that >45% ME of protein may be needed
must consume animal ﬂesh and fat to meet their during weight loss due to the severe restric-
nutritional needs, or their diets must be supple- tion of intake necessary to achieve reduction
mented appropriately with the necessary amino in calories and loss of weight.40,41
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 289
CE Feline Obesity
Obese cats appear to adapt to lower- drates; on the contrary, they can digest, absorb,
protein, higher-carbohydrate diets; however, and use them quite well. Nevertheless, the type
obese cats on high-protein diets have not only of carbohydrate is important, as there are signif-
improved insulin sensitivity but also greater icant differences in glycemia, postprandial glu-
energy and fat metabolism, resulting in great cose levels, insulin secretion, and food intake
loss of fat mass during calorie restriction and between normal-weight and obese cats.47,48
weight loss.39 Increased protein intake may be
particularly important in cats after weight loss, Fat
as research also shows that energy expendi- The role of dietary fat is also very important
ture remains decreased.44 in feline obesity, as fat provides the greatest
In summary, high protein levels are essen- amount of energy per gram of diet. As a result,
tial for preservation of lean body mass dur- there are a number of commercially available
ing calorie restriction and weight loss in obese low-fat feline diets for calorie control. Further,
cats and are important for increasing insulin several recent studies show that controlling
sensitivity, thereby preventing further devel- calories from fat in weight-loss programs
opment of glucose intolerance. In addition, is essential to achieving successful weight
TO LEARN MORE high-protein diets (>45% protein ME) allow a loss.19,21 Nevertheless, dietary fat has many
more optimum metabolic status in lean cats. roles in metabolism beyond being a power-
ful source of energy, and there are key differ-
Carbohydrates ences in feline requirements for fat that must
While protein is a very important component of be considered when choosing a diet.
the feline diet, it is only one part. Carbohydrates As carnivores, cats require additional sup-
serve two major purposes: as an energy source plementation of fatty acids (especially arachi-
Your gateway to
trusted resources for (simple carbohydrates, such as starches) or as donic acid) and fat-soluble vitamins in their
your veterinary team: dietary ﬁber (complex carbohydrates). The role diet that normally would come from the fat
of ﬁber is discussed in a separate section below. stores of prey. Also, fat is a major palatabil-
Web exclusives Carbohydrates are a major part of most dry and ity enhancer, and cats often reject diets with
Articles some canned commercial feline and canine diets too little fat or in which the fat is oxidized.
News due to issues of processing, preservation, and cost. BOX 4
Video The digestibility and glycemic index of dietary car-
VLS online store bohydrate varies by source: highly digestible car- Major Metabolic/Anatomic
bohydrates include cooked white rice and potato; Differences in Feline
Compendium... less digestible sources include complex grains (e.g.,
and so much more!
barley, wheat, whole corn). Carbohydrates in high-
quality commercial pet foods are generally highly Compared With Omnivoresa
digestible and provide a readily available energy
source. If the pet is active and needs energy, car- Lack of a sweet taste receptor and gene
bohydrates are used efﬁciently; however, if the for sweet taste
pet is sedentary, any carbohydrates that are not Lack of salivary amylase (enzyme that
used for energy are stored as fat. initiates digestion of starches)
The amount and type of carbohydrate in the Low levels (5% to 10%) of intestinal
feline diet are of considerable importance for amylase and intestinal disaccharidases
several reasons: (1) cats’ ability to handle dietary Minimally functioning levels of hepatic
carbohydrate loads are very different from those glucokinase (inducible enzyme that affects
of omnivores38,45 (BOX 4); (2) because cats use
protein for energy, even when excess energy Minimally functioning levels of hepatic
glycogen synthetase (enzyme that
is available in their diet, sedentary indoor cats
converts glucose to glycogen)
often do not use the carbohydrate energy pres-
Lack of fructokinase and ability to
ent in a diet38,46; and (3) high-carbohydrate diets
metabolize fructose sugars
result in a reduced resting energy metabolism,
so cats must consume less food to maintain a
Zoran DL. The unique nutritional needs of the cat. In: Ettinger
appropriate body weight.39 S, Feldman E, eds. Textbook of Veterinary Internal Medicine. 7th
ed. 2009, in press.
However, cats are not unable to use carbohy-
290 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
Feline Obesity CE
However, while reducing fat is an important energy metabolism. Ideally, weight-loss diets
method of controlling calories in feline diets, should contain protein levels >45% ME and
there are no studies in cats showing the ideal be low in fat and carbohydrates. The number
amount of fat in the diet. And as with protein of dry diet choices that meet this proﬁle is
and carbohydrates, it is essential to consider extremely small, primarily because most high-
the whole: diets for weight loss in cats should protein, low-carbohydrate dry foods are for-
ideally be higher in protein (at least >45% ME), mulated as either diabetic or kitten diets and
lower in fat (to control calories) but contain- thus contain a large number of calories due
ing enough essential fatty acids to meet feline to a high fat content. For example, a typical
requirements, and lower in carbohydrates (to dry diabetic or kitten food contains 500 to 600
prevent reduction in energy metabolism and kcal/cup of food. As a result, it is extremely
conversion of excess carbohydrate to fat). difﬁcult to feed an appropriate amount to a
cat that requires weight loss, which, in an
Fiber obese cat, may be as low as 130 to 150 kcal/
The ﬁ nal dietary component to consider in day. In this scenario, the amount of the high-
weight-loss diets is ﬁber. Most weight-loss diets calorie diabetic dry food fed at a meal will be
add insoluble or mixed sources of ﬁber, such small (< 1/8 cup twice daily)—likely too small
as cellulose or beet pulp. Dietary ﬁbers have to achieve any sense of “fullness” and result-
been used in weight-loss diets for many years ing in annoying begging behavior that makes QuickNotes
because of their ability to dilute calories and owner compliance with feeding recommenda-
Weight loss in
provide bulk to the diet so that larger volumes tions very difﬁcult.
of food can be eaten during energy restriction. This point cannot be overstated: too many
obese cats is dif-
Fiber aids in glycemic and weight control by calories of any kind, including protein calories, ﬁcult and requires
promoting slow, sustained absorption of glu- will cause weight gain or failure to lose weight. appropriate dietary
cose (and other nutrients) from the gastroin- Thus, at this time, the best commercial diets intervention to pre-
testinal tract and by increasing the speed of for achieving a high-protein, low-carbohydrate, serve muscle mass,
passage of food through the small intestine. low- to moderate-fat proﬁle that can provide careful control of
However, this effect, while beneﬁcial for weight reasonable portion sizes are canned cat foods. intake, and frequent
loss, results in reduced digestibility of protein49 For example, a typical diabetic (high-protein/ monitoring to make
and may have other untoward effects, such low-carbohydrate) canned diet contains 165 to
as increased fecal volume, constipation, food 190 kcal/5.5-oz can. Thus, when the target for
refusal, and dry skin.50 As a result, many own- caloric intake is 180 kcal or less, it can be easier
ers and cats do not tolerate diets with moder- to achieve the high protein necessary to pre-
ate to high levels of dietary ﬁber (>15% dry serve muscle mass in a portion-controlled diet
matter). No studies demonstrate an optimum with these foods. However, canned foods can
amount or type of dietary ﬁber for use in cat also be high in carbohydrate or low in protein
foods for any purpose; however, a moderate or have poor-quality ingredients, resulting in
amount (5% to 12% dry matter) of mixed ﬁber ineffective or unhealthy weight loss. One size
may be best.50 does not ﬁt all in cat foods, and careful read-
If a moderate- to high-ﬁber diet is cho- ing of the label can help determine the protein,
sen, the effects on protein digestibility must carbohydrate, and fat levels, which is the start
be considered and an appropriate amount of of the process.
protein added to the food to prevent a reduc-
tion in protein availability. As with any dietary Creating a Treatment Plan
strategy, increased ﬁber in the diet should Successful weight loss in an obese cat requires
not be considered a “cure-all” for weight loss, patience, setting goals, frequent monitoring
but it can be included as part of the overall and readjustment of strategy, and an under-
approach to controlling caloric intake. standing that reversing obesity is a challenge
similar to the management of any chronic
Choosing a Weight-Loss Diet medical condition. Persistence and diligence
Healthy weight loss requires loss of adipose are essential. The key is to set a target calorie
tissue along with maintenance of lean body intake, weigh the cat monthly, and adjust the
mass, which is an important arbiter of basal amount of food based on weight loss. While
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 291
CE Feline Obesity
the most appropriate rate of weight loss is tered cats are at risk for becoming obese due
debated, most sources agree that a goal of 1% to the changes in their hormonal balance that
weight loss per week or 3% to 4% per month affect appetite, energy balance, and fat metab-
is a safe target.8,12,29 If, during periods of moni- olism. Because of these changes, food intake
toring, this goal is not being achieved, calories must be carefully restricted following gonadec-
must be reduced by 5% to 10% and the effects tomy in all cats, and free-choice feeding of dry
of the new amount monitored. foods should be strongly discouraged.
To achieve loss of fat mass, the weight-loss In indoor cats, for which exercise is reduced
program must consider the cat’s body condition by the nature of their lifestyle, energy restric-
at the start of weight loss, the degree of calorie tion also becomes paramount to preventing or
restriction required, the desired rate of weight correcting obesity. Energy restriction can be
loss, and the cat’s environment and ability to achieved by low-fat, high-ﬁber diets, but many
increase exercise.29 BOX 2 provides a step-by- of these diets are not high enough in protein to
step overview of the process. Although this strat- preserve muscle and thus result in loss of mus-
egy is relatively straightforward (reduce energy cle mass, unhealthy weight loss, and a strong
intake), it requires patience; careful, long-term tendency to regain weight. High-protein, low-
monitoring; encouragement and support for the carbohydrate, low-fat diets are ideal for weight
owner; and frequent assessment and readjust- loss in cats because they preserve muscle mass
ment to meet the needs of the cat. while restricting energy sources to induce fat
loss. However, portion control is ultimately the
Conclusion key to controlling energy intake and is most
The key to obesity prevention (or cor- easily achieved by feeding canned food with a
rection) is balancing the energy intake/ protein content of >45% ME and a carbohydrate
energy expenditure equation. Because content of <10% ME. The key to any success-
For a more detailed obesity is incredibly difﬁcult to reverse ful weight-loss program is patience, persistence,
discussion of how free-choice in adult cats and, in many cases, requires frequent and careful monitoring and assessment,
feeding negatively affects
lifelong management because of changes and readjustment of the caloric intake and diet
cats’ health, please visit
in energy metabolism and hormone status, as needed to achieve fat loss and preserve lean
prevention is an essential goal. All neu- muscle tissue.
1. Scarlett JM, Donoghue S, Saidle S, et al. Overweight cats: 11. Wisse BE. The inﬂammatory syndrome: the role of adi- 20. Beata CA. Feline behavior: can nutrition really make
prevention and risk factors. Int J Obes 1994;18:522-528. pose tissue cytokines in metabolic disorders linked to obe- the difference. Royal Canin Feline Symp 2007:30-33.
2. Armstrong PJ, Lund EM. Changes in body condition and sity. J Am Soc Nephrol 2004;15:2792-2800. 21. National Research Council. Nutrient Requirements
energy balance with aging. Vet Clin Nutr 1996;3:83-87. 12. Laﬂamme DP. Understanding and managing obesity. of Dogs and Cats. Washington, DC: National Academy
3. Lund EM, Armstrong PJ, Kirk CA, et al. Health status Vet Clin North Am Small Anim Pract 2006;36:1283-1295. Press; 2006.
and population characteristics of dogs and cats examined 13. Fettman MJ, Stanton CA, Banks LL, et al. Effects of 22. Hill RC. Challenges in measuring energy expenditure
at private veterinary practices in the United States. JAVMA neutering on body weight, metabolic rate, and glucose in- in companion animals: a clinician’s perspective. J Nutr
1999;214:1336-1341. tolerance of domestic cats. Res Vet Sci 1997;62:131-136. 2006;136:1967S-1972S.
4. Robertson ID. The inﬂuence of diet and other fac- 14. Martin L, Siliart B, Dumon H, et al. Leptin, body fat con- 23. Kienzle E, Edstadtler-Pietsch G, Rudnick R. Retrospec-
tors on owner perceived obesity in privately owned cats tent and energy expenditure in intact and gonadectomized tive study on the energy requirements of adult colony cats.
from metropolitan Perth, Western Australia. Prev Vet Med adult cats: a preliminary study. J Anim Phys Anim Nutr J Nutr 2006;136:1973S-1975S.
1999;40:75-85. 2001;85:195-199. 24. Belsito KR, Vester BM, Keel T, et al. Impact of ovariohys-
5. Diez M, Nguyen P. The epidemiology of canine and 15. Harper EJ, Stack DM, Watson TDG, et al. Effects of terectomy and food intake on body composition, physical
feline obesity. Waltham Focus 2006;16:2-8. feeding regimen on body weight, composition, and con- activity, and adipose gene expression in cats. J Anim Sci
6. Prahl A, Guptill L, Glickman NW, et al. Time trends and dition score in cats following ovariohysterectomy. J Small 2009;87:594-602.
risk factors for diabetes mellitus in cats presented to veteri- Anim Pract 2001;42:433-438. 25. Bufﬁngton CAT. Dry food and risk of disease in cats.
nary teaching hospitals. J Feline Med Surg 2007;9:351-358. 16. Hoenig M, Ferguson DC. Effects of neutering on hor- Can Vet J 2008;49:561-563.
7. Biourge VC, Massat B, Groff JM, et al. Effects of pro- monal concentrations and energy requirements in male 26. Patterson CM, Levin BE. Role of exercise in the cen-
tein, lipid, or carbohydrate supplementation on hepatic lipid and female cats. Am J Vet Res 2002;63:634-639. tral regulation of energy homeostasis and in prevention of
accumulation during rapid weight loss in obese cats. Am J 17. Nguyen PG, Dumon HJ, Siliart B, et al. Effects of dietary obesity. Neuroendocrinology 2008;87:65-70.
Vet Res 1994;55:1406-1415. fat and energy on body weight and composition after go- 27. Indoor cat needs. The Indoor Cat Initiative. Accessed
8. German AJ. The growing problem of obesity in dogs nadectomy in cats. Am J Vet Res 2004;65:1708-1713. May 2009 at vet.ohio-state.edu/ 747.htm.
and cats. J Nutr 2006;136:1940S-1946S. 18. Martin LJM, Siliart B, Dumon HJ, et al. Spontaneous 28. Roudebush P, Schoenherr WD, Delaney SJ. An evi-
9. Kealy RD, Lawler Dr, Ballam JM, et al. Effects of diet hormonal variations in male cats following gonadectomy. dence based review of the use of therapeutic foods, own-
restriction on life span and age–related changes in dogs. J Feline Med Surg 2006;8:309-314. er education, exercise, and drugs for the management of
JAVMA 2002;220:1315-1320. 19. Backus RC, Cave NJ, Keister DH. Gonadectomy and obese and overweight pets. JAVMA 2008;233:717-725.
10. Staiger H, Häring HU. Adipocytokines: fat derived high dietary fat but not high dietary carbohydrate induce 29. German AJ, Martin L. Feline obesity: epidemiology,
humoral mediators of metabolic homeostasis. Exp Clin gains in body weight and fat of domestic cats. Br J Nutr pathophysiology, and management. In: Pibot P, Biourge V,
Endocrinol Diabetes 2005;113:67-79. 2007;98:641-650. Elliott D, eds. Encyclopedia of Feline Clinical Nutrition. Aim-
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argues, France: Aniwa SAS; 2008:4-43. 38. Morris JG. Idiosyncratic nutrient requirements of cats expenditure in cats that is maintained after weight regain.
30. Scarlett JM, Donoghue S. Associations between body appear to be diet-induced evolutionary adaptations. Nutr J Nutr 2008;138:856-860.
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31. German AJ, Holden SL, Moxham G, et al. A simple, re- 39. Hoenig M, Thomaseth K, Waldron M, et al. Insulin predict the glycemic responses to food in cats [abstract].
liable tool for owners to assess the body condition of their sensitivity, fat distribution, and adipocytokine response Proc Nestle Purina Forum 2007:73.
dog or cat. J Nutr 2006;136:2031S-2033S. to different diets in lean and obese cats before and af- 46. Morris JG, Rogers QR. Metabolic basis for some of
32. Laﬂamme DP. Development and validation of a body ter weight loss. Am J Physiol Regul Integr Comp Physiol the nutritional peculiarities of the cat. J Small Anim Pract
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Pract 1997;25:13-18. 40. Laﬂamme DP, Hannah SS. Increased dietary protein 47. Bouchard GF, Sunvold GD. Effect of dietary carbohy-
33. Burkholder WJ. Use of body condition scores in the promotes fat loss and reduces loss of lean body mass drate source on post prandial plasma glucose and insulin
clinical assessment of the provision of optimal nutrition. during weight loss in cats. Intern J Appl Res Vet Med concentrations in cats. In: Reinhert GA, Carey DP, eds. Re-
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34. Hawthorne A, Butterwick RB. Predicting the body 41. German AJ, Holden S, Bissot T, et al. Changes in body tion Symposium. Wilmington, OH: Orange Frazier Press;
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[abstract]. J Vet Intern Med 2000;14:365. of weight loss. J Feline Med Surg 2008;10:452-459. bohydrate source affects glucose control, insulin se-
35. Burkholder WJ. Precision and practicality of methods 42. Szabo J, Ibraham WH, Sunvold GD, et al. Inﬂuence cretion, and food intake in overweight cats. Nutr Res
assessing body composition of dogs and cats. Compend of dietary protein and lipid on weight loss in obese ovari- 2004;24:447-467.
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36. Elliott D. Is my cat fat? Proc Nestle Purina Nutr Forum 43. Michel KE, Bader A, Shofer PS, et al. Impact of time lim- fects of six carbohydrate sources on diet digestibility and
2007:28-32. ited feeding and dietary carbohydrate content on weight loss postprandial glucose and insulin responses in cats. J
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CREDITS CE TEST 1 This article qualiﬁes for 3 contact hours of continuing education credit from the Auburn University College of Veterinary
Medicine. Subscribers may take individual CE tests online and get real-time scores at CompendiumVet.com. Those who wish to apply this
credit to fulﬁll state relicensure requirements should consult their respective state authorities regarding the applicability of this program.
1. A cat with an ideal weight of ____lb and an hormonal imbalances after neutering. 8. In neutered cats, energy intake recommen-
actual weight of ____lb would meet the cur- b. a sedentary, indoor lifestyle. dations on commercial food labels must be
rently accepted deﬁnition of obese. c. overfeeding. decreased by approximately ________ to
a. 9; 9.9 d. all of the above prevent the development of obesity.
b. 7; 8.2 a. 20%
c. 11; 13.5 5. Successful weight loss in obese cats is b. 25%
d. 14; 16.4 characterized by all of the following except c. 30%
a. preservation of lean muscle mass by d. 35%
2. Cats digest carbohydrates differently from feeding a high-protein diet.
omnivores because they b. loss of fat mass at a rate of 1% to 2% 9. Which statement regarding label recom-
a. have high levels of intestinal amylase. per week. mendations for feeding cats is true?
b. lack salivary amylase. c. control of caloric intake by meal feeding a. They are based on twice the mainte-
c. have increased function of hepatic and portion control. nance energy requirement.
glucokinase. d. activity restriction. b. They are based on the needs of intact,
d. have high levels of fructokinase. active cats.
6. Which condition has not been associated c. Pet food manufacturers overestimate
3. Which feeding approach is most likely to with obesity in cats? energy needs to avoid underfeeding
lead to healthy weight loss? a. hepatic lipidosis cats.
a. meal feeding of high-carbohydrate dry b. hypertrophic cardiomyopathy d. They are based on the needs of neu-
food only c. diabetes mellitus tered cats.
b. free-choice feeding of high-carbohydrate d. osteoarthritis
canned food only 10. Weight-loss diets for obese cats
c. free-choice feeding of high-protein dry 7. Which clinical method of evaluating should contain _______ ME of protein
food only body fat mass in cats is most likely to be to promote fat loss and prevent loss of
d. meal feeding of high-protein canned affected by technical issues? muscle mass.
food only a. BCS a. >30%
b. morphometric measurement b. >35%
4. Risk factors for obesity in cats include c. BIA c. >40%
a. appetite and energy changes caused by d. BMI d. >45%
CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 293
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Intervet/Schering-Plough Animal Health Mometamax 253, 254
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Merial Quick Course: Kitten Vaccinations 282–283
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