UK Vet Companion Animal - Dos and don'ts for reducing feline anxiety in the veterinary environment

Abstract

Visits to the veterinary practice can be extremely stressful for feline patients and this is evident in many cats as soon as they enter the hospital. Some of the challenges that the feline patient has to endure in the practice include lack of control through forced restraint and handling, changes in routine, unfamiliar scents, strange noises and different people and animals. Being proactive in creating a positive patient experience should therefore be a priority for every member of the veterinary team and this should extend to every department of the hospital. This article considers the cat's species-specific requirements and looks at how veterinary professionals can attempt to meet these needs within the veterinary environment. A number of useful strategies are presented to help staff facilitate a feline-friendly approach in all the different areas of the practice.

Visits to the veterinary practice can be extremely stressful for feline patients (Horwitz and Little, 2015; Lloyd, 2017) and this is evident in many cats as soon as they enter the hospital. Stress affects emotional wellbeing and, in the long-term, can impact on health (Mills, 2015). Some of the challenges that the feline patient has to endure in the practice include lack of control through forced restraint and handling, changes in routine, strange noises and scents, unfamiliar people and animals. Being proactive in creating a positive patient experience should therefore be a priority for every member of the veterinary team and this should extend to every department of the hospital.

The primary goal of feline-friendly veterinary care is to make the cat feel safe and secure throughout its medical experience and every member of staff has a crucial role to play in this endeavour. Initiatives such as the Cat Friendly Clinic programme promoted by the International Society of Feline Medicine (ISFM) provide practical recommendations, helping practices become more proficient at meeting the cat's unique needs (Endersby, 2018).

Cats are particularly sensitive to their surroundings and visits to the veterinary practice present them with many challenges. As a species that is selectively social, they avoid confrontation with other unfamiliar cats through avoidance or hiding. Without access to these coping mechanisms they may use defensive aggression (Rodan et al, 2011). Simple measures such as allowing a cat to feel hidden by using towels and covers may enhance a cat's sense of security and facilitate safer handling.

Therefore, if all staff members can appreciate the cat's unique needs and make appropriate adjustments to the environment and working practices, optimal healthcare can be delivered without compromising feline welfare. This article provides an overview of the key considerations through some dos and don'ts for reducing feline stress throughout the veterinary environment. It is presented in a series of tables and may be useful as a quick reference. As such, it is not intended as a full review article.

Understanding the cat's needs

In the reception and waiting area

The reception and waiting area can present a range of stressors including: unfamiliar noises and scents, people, animals and being confined to a carrier. Making small changes and modifying the waiting room environment can help reduce a cat's stress levels (Table 1). In turn, this helps make subsequent examinations and procedures less challenging.

Table 1. Dos and don'ts in the reception/waiting room

Do	Don't	How	Why
Provide the cat with a sense of security and safety	Allow cats to feel vulnerable	Schedule cat-only consultation slots Provide separate waiting areas or use walls and partitions to segregate species At busy times, suggest that cats wait in a covered carrier in the car	Separate waiting areas are proposed to be beneficial in alleviating patient stress (Rodan et al, 2011; Montrose et al, 2016) To feel safe, cats usually chose to retreat to a private secluded location
Provide clean covers/towels to drape over cat carrier	Allow cats to be looked at through crates and baskets	Have a supply of clean carrier covers in the waiting area and on the reception desk	Direct eye contact can be perceived as a threatening gesture Hiding enhances a cat's sense of security (Ellis et al, 2013)
Ensure covers used for carriers are free from the scent of others	Allow a cat to be in close proximity to another cat's scent	Use freshly laundered covers free from strong scents and animal odours	A cat is sensitive to their own scent profile and may feel insecure and threatened by the scent of another
Encourage owners to place the cat carrier in a raised location (Figure 1)	Place carriers at floor level	Provide raised locations for cat parking Use shelves, seats and benches	Cats feel more secure in a raised, hidden, location
Manage the area around the reception desk to prevent a gridlock of people and animals	Allow a build-up of people at the reception desk	Book appointments to allow for a free flow of client arrivals If busy, move the cat and their owner into a holding area until they can be checked in	The cat will feel vulnerable if suspended in an unsteady carrier A dog sniffing around the carrier will induce fear
Ventilate the waiting area to avoid a build-up of stress pheromones	Ignore the negative effect that stress pheromones can have on some animals	A range of ventilation systems are available to suit various budgets	Alarm pheromones can be detected in the environment and may contribute to the stress response (McConaghy, 2013)
Consider using pheromone therapy in the waiting room environment	Forget to follow the manufacturer's instructions to ensure maximum efficiency	Use Feliway Classic diffusers (Ceva Animal Health) in the waiting area	The feline facial pheromone analogue, (F3) Feliway Classic (CEVA), has been shown to help reduce stress (Mills, 2002)

Figure 1. Place cats in a raised location and cover carriers to ease stress (Picture courtesy of Swanbridge Veterinary Hospital).

In the consulting/examination room

The examination experience can be difficult for many cats. An invasion of their personal space and forced restraint can contribute to their anxiety and mood state. Addressing some of the cat's environmental needs and applying principles that take their social preferences into account should help reduce their anxiety, promote feline welfare and prevent staff injuries (Table 2).

Table 2. Dos and don'ts in the consulting/examination room

Do	Don't	How	Why
Give the cat time to process its surroundings before attempting any handling	Try and physically remove the cat from their carrier	Let the cat dictate the pace and, where possible, allow them to leave the carrier in their own time Encourage owners to use carriers that split in to two	Cats are highly attuned to their own surroundings and therefore need time to adjust to a new environment The top lid can be lifted so the cat can still remain in an area of perceived safety during the examination
Avoid signals that can be perceived as a threat	Make direct eye contact or loom over the cat	In most cases, it is still possible to carry out a clinical examination by standing alongside the cat without making prolonged eye contact	Hostile gestures can instill fear
Provide an option for hiding during the examination	Forget to provide cats with the opportunity to take cover if necessary	Lay towels or blankets underneath or alongside the cat to provide them with somewhere to bury their heads and to use as a body wrap	Hiding is a coping strategy If a cat cannot hide or flee they may freeze or fight in self-defence Thick towels provide a degree of handler safety
Allow the cat to retain a sense of control and handle with due care	Scruff or pin	Use a gentle, confident approach Allow all four feet to remain on a solid surface	Forced restraint removes a cat's sense of control Scruffing can mimic neck biting which may be interpreted as a threatening gesture
Respect the cat's sense of smell and scent profile	Remove or mask the cat's familiar scent	Have items nearby that carry the cat's own scent signals on them (e.g. bedding, towels, blankets) Use synthetic facial pheromones (Feliway Classic, Ceva Animal Health) in the handling environment	Cats rely heavily on familiar scent signals for orientation and to feel safe F3 pheromones can help provide a calming effect in an unfamiliar environment
Use appropriate chemical restraint if there is no other option but to proceed with handling	Persist in trying to handle and restrain a cat that is very stressed	Use a suitable sedative that reduces stress or prescribe an anxiolytic that can be given at home before the appointment *	The escalation of stress is a welfare issue to the patient and can lead to aggression and subsequent injuries to staff

* Medication chosen should always be tailored to the individual based on a thorough review of the behavioural and medical history (screen for underlying disease, drug interactions or contraindications) and should always be provided alongside management advice.

In the ward (for day cases)

Cats will inevitably feel uncomfortable within the veterinary environment. The problem will be exacerbated the longer the period of confinement. Although trying to meet the cat's environmental needs within the ward is always going to be a challenge, there are a number of approaches that can be adopted in order to minimise stress (Table 3).

Table 3. Dos and don'ts in the day ward

Do	Don't	How	Why
Separate cats from other species	Allow cats to share a ward with other species (where possible)	Separate wards are gold standard Using partitions or hospital screens are suitable alternatives	Being in the presence of a dog can induce fear and stress Seeing prey species can heighten arousal and frustration (and is a welfare issue to the prey species)
Avoid cats being able to see one another	Permit visual contact with others	Design wards accordingly. Use towels and hospital screens as visual blockers Tape paper on the front of the pen to partially cover the front	Cats are selectively social Direct eye contact is confrontational and threatening to most cats
Place litter trays in a private location (and away from food or water stations)	Forget the cat's sense of privacy	A cardboard box placed over the litter tray creates a closed arrangement (Figure 2) Add a shelf or install platforms in cat accommodation and place litter trays beneath	Cats like to feel a sense of privacy when toileting
Provide somewhere suitable for the cat to hide and sleep	Allow the cat to feel insecure	Use some of the cat's own familiar bedding for comfort, scent familiarity and to hide under Make use of 3D space Use a Hide and Sleep (available from The Cat's Protection) (Figure 3)	To provide security and familiarity To provide elevated locations
Keep noise to a minimum and prevent bright glare from lights	Forget that cats prefer a quiet, calm and relaxing environment	Keep doors shut and use notices as reminders to staff Create and follow hospital policies and protocols Use dimmer switches	To meet the cat's needs, enhance feelings of calm to create a non-threatening environment
Use pheromone therapy in the ward	Forget to follow the manufacturer's instructions for optimum effect	Diffusers and sprays can be used in the ward environment and on bedding	Evidence suggests that exposure to the feline facial pheromone analogue (F3) helps hospitalised cats feel more at ease (Griffith et al, 2000).
Be aware of the cat's scent profile when cleaning their accommodation	Remove the cat's scent profile when cleaning	Operate a double bedding system: one layer of bedding can be removed leaving a layer that contains their scent	Cats need a familiar scent to feel secure
Ensure the compatibility of cats from the same household before putting them together in the same pen	Assume that cats that live together are well-bonded	Find out from the owner if the cats are affiliated by asking if they choose to sleep at close proximity, allo-groom or allo-rub (Figure 4) Make ongoing observations	Cats cannot maintain their own territory when sharing a small space Just because cats live together does not mean they will be affiliated to one another
Ensure that cats are kept separately when recovering from a general anaesthetic	Place cats together when coming round from a general anaesthetic	Separate each cat so they have their own housing	Cats recovering from a general anaesthetic will be disorientated and confused This can cause conflict and there is a danger of long-term damage to their relationship if fighting ensues
Advise owners with multi-cat households to keep the hospitalised cat in a separate room until fully recovered and all cats are calm	Introduce a cat that has been hospitalised to the others in the household until it has fully recovered from the effects of general anaesthesia	Keep the cat separated in a room ensuring it has all its resources available Use synthetic pheromones in the home, during and after hospitalisation, to maintain an existing scent profile and enhance harmony Feliway Classic and Feliway Friends (Ceva Animal Health) can be used together	Odours from the veterinary practice (e.g. anaesthetics, medication and cleaning products) can disrupt the home's communal scent Feliway Classic can help enhance the environment and Feliway Friends can help to reduce inter-cat tension and conflict (Ceva Animal Health)

Figure 2. Cover or hide litter trays to respect the cat's privacy in the ward.

Figure 3. For long-term stays consider using a Hide and Sleep developed by Cats Protection.

Figure 4. Cats choosing to sleep together is one sign of affiliation (photo courtesy of Jess Wardale RVN).

Longer periods of hospitalisation require a more thorough and detailed plan of action to prevent chronic stress. This includes the layout and furnishing in the pen, and taking a full history from owners to enable the veterinary team to understand the cat's likes and dislikes. Providing feeding enrichment, opportunities to play and ensuring that behavioural observations and patient assessments are continually made and recorded are important (Carney et al, 2012).

In the preparation room

The same principles used in the examination room can be adhered to in the preparation area. However, additional things to consider include purchasing cat-friendly equipment. This may include small fur clippers that tend to be quieter and are less likely to induce a startle response. Handling should always be sympathetic to the cat's needs. Adopting the mantra used by Cats Protection: ‘Less is more, four on the floor’ is a good rule.

Scruffing a cat is not a positive experience and being pinned down can be interpreted as a threatening gesture (Rodan et al, 2011). The area around the neck is often targeted in a cat fight and so handling a cat there is likely to cause fear. As such, scruffing should be avoided.

Conclusions

This article has demonstrated a number of practical strategies that can be easily adopted and implemented within the veterinary environment. By making small changes and anticipating the cat's environmental needs, the veterinary team can significantly improve feline welfare, leading to less challenging and stressful examinations for themselves and their feline patients.

KEY POINTS

Cats are selectively social.
To cope with stress, cats often chose to hide in private, secluded, raised locations.
Aggression is a consequence of being unable to access coping mechanisms.
Meeting the cat's environmental and social needs improves cat welfare and optimises veterinary health care delivery.

Useful resources for the veterinary team

https://catvets.com/public/PDFs/ClientBrochures/Cat-to-Vet-HandoutPrint.pdf

https://www.cats.org.uk/media/1725/cp_behaviour_guide-web.pdf

https://www.partnersforhealthypets.org/practice_feline.aspx

https://www.catsprotectionshop.co.uk/acatalog/Hide—Sleep-81399.html