Successful kitten consults

Introduction

According to Leonardo Da Vinci “The smallest feline is a masterpiece”, so it should perhaps not be surprising that kittens are incredibly popular with animal lovers, and therefore make up a significant proportion of the veterinary patient population in both first opinion small animal and feline specialty practices. Providing a positive experience for every owner and kitten at both their initial and consecutive clinic visits is critical, with the start of life stage being the veterinary team’s opportunity to educate the client and develop a long-term and trusted relationship, which will lay the foundation for a lifetime of preventive healthcare for their pet.

Understanding the feline patient

It is vital to understand the feline patient, not just in their needs, but also how they – and their owners – perceive the veterinary visit. More than any other species, cats need good preventive healthcare and early disease detection, which is only possible with regular veterinary visits. Cats are masters at hiding illness, and their signs of sickness are subtle. Yet despite the requirement for regular preventive healthcare, cat owners visit veterinary practices far less than dog owners, although a 2006 US survey indicates that 78% of cat families considered their pets to actually be family members 1. Part of the reason that cats are less likely to be taken to the veterinary clinic is the “stress” of the veterinary visit, for both cat and the client. A recent study revealed that 58.2% of clients hate bringing their cat to the veterinarian and 38% feel stressed just thinking about it 2, and in reality, such visits are often extremely challenging for cats, clients and the veterinary team as well. A further factor to consider is owner perception; in North America, the majority of cats are kept as exclusively indoor pets, and their owners often falsely believe that they are free from disease risk. This “Myth of the Indoor Cat” can make it difficult for veterinary teams to convince clients to bring their cats in for an annual or biannual appointment. However, the multiple visits required to complete the necessary preventive healthcare steps for a kitten offer the opportunity to create a wonderful “cat centric” experience, one that is both enjoyed by the client and does not result in undue stress for the patient. In addition, the appointments and communications provide an ideal time to educate the client and plant the seeds for a future of regular veterinary care.

It is essential to recognize that for the cat and the client, a feline veterinary visit lasts much longer than the time of the scheduled appointment. It begins well before arrival at the clinic, and ends much later – sometimes days – after the appointment, with a post-visit feline household that is unhappy and unsettled. From the carrier to the traveling, to the exposure to foreign sights, smells and sounds at the clinic, the cat has many valid reasons to be distrustful. Their solitary nature, and the fact that they evolved at risk of being preyed upon, leads them to be naturally self-defensive, with the need to protect themselves at all times. In addition, cats have good long-term memory, and previous negative experiences can affect their response in a similar situation later on, so a bad clinic visit can negatively impact a cat’s welfare both short- and long-term 3,4. It is therefore imperative for the clinic personnel to prioritize a Cat Centric experience for all feline patients and clients alike. Fortunately, with resources such as the AAFP*/ISFM** Cat Friendly Practice^® Program, and the AAFP Cat Friendly Certificate Program for individuals, veterinary teams are developing a much better understanding of this amazing species and are now able to take measures to prevent environmental and handling stressors, resulting in improved patient and client experiences.

* American Association of Feline Practitioners

** International Society for Feline Medicine

Getting a kitten for the first time – or adding another kitten to an existing feline family – is an exciting time for the owner, and the initial communication between the clinic and the new cat parent is critical. It needs to be engaging, educational and compassionate. Even if there is already a long-standing relationship with a client, this is the opportunity to share in their excitement and create or enhance your bond with them. Clients need to feel from the very start that the whole veterinary team has a true awareness and concern for their cat. For example, the receptionist needs to show an interest and connect with the client by asking questions about where they got the kitten, how they chose the name, and finding out little things that are unique to the new family member. It is beneficial to include this information in the cat’s records, as it allows all team members to relate with the client on a more personal basis.

Making for easier travel

As mentioned earlier, the veterinary visit for the cat and its family begins long before the appointment. For many cats, the carrier is the initial roadblock to a successful visit. Getting a kitten into a carrier for the first time might not be too much of a challenge, but it is very likely to become more of an issue with repeated visits. In the author’s opinion, the best carriers are inexpensive hard-sided ones that open from both the top and front, and can also be taken apart in the middle (Figure 1). The alternative is the soft “pod-like” carriers that have a bed that the cat sleeps in, with a zippered closure. Either option allows for an easily removable top which avoids the traumatic “dumping or dragging” of a cat from its carrier. It also permits an animal which is fearful, anxious, or in pain to stay in the bottom half of the carrier for the entire examination. Although the top of the carrier should be easily removable, it needs to be solid enough to ensure it does not come apart when being carried, and all carriers should be double-checked for stability prior to use. In addition, educating the client to make sure they support the carrier from the bottom and carry it level with the ground will decrease the kitten’s stress and the potential for motion sickness. A thick blanket or towel should be placed in the carrier for comfort and to help stop the kitten from sliding around. Synthetic pheromone analogues can be sprayed onto the bedding 30 minutes before travel to ease apprehension. The first kitten consult is also the opportunity to advise the client not to store the carrier in a dusty cupboard, shed or garage, where it remains out of site until it is required for a veterinary visit. 

Ideally, kittens and cats can be trained to like their carrier and to become accustomed to travel. Their self-defensive nature means they are very suspicious of anything new in the environment, and the appearance of the carrier is usually a signal to quickly hide as far under the bed as possible. Luckily, kittens are naturally curious and more adventuresome than their adult counterparts and are not initially concerned with the presence of a carrier, and owners should be encouraged to take advantage of this. Advise the client to leave the carrier (with the door open or removed) in a room that the kitten frequents, set up as a comfortable bed complete with thick blanket, toys and treats. It is good idea to get kittens accustomed to automobile travel by advising clients to take them for short rides in their carrier, but stress the importance of never leaving a pet in the vehicle unattended. The safest place for a carrier is in the footwell behind the front seats; otherwise, the carrier should be held in place with a seat belt. Partially covering the carrier with a towel sprayed with synthetic pheromones again provides additional comfort to the kitten.

The rule of thumb for adult cats is one cat for carrier, but the author is comfortable for a pair of kittens (or even the whole litter) to travel to the clinic in one carrier for the first couple of visits. Once they start getting a little bigger and more independent, it is critical that each kitten has their own carrier. Adult cats should preferably be fasted prior to a clinic visit so that treats, which are wonderful distractions, are more interesting to the patient and more readily received. However, kittens are so curious that toys work as great diversions and treats can be as interesting to check out as they are to eat. This makes fasting a kitten unbeneficial, and it is not recommended anyway as they have such a high metabolic rate.

Appropriate preparation by the reception team will set the first and subsequent kitten visits up for success, and posting or emailing a welcome letter and information sheet that covers the important topics outlined above, including pictures of the preferred carrier designs, ahead of the appointment will be of enormous benefit.

Cat friendly and cat centric clinic experiences

The waiting room/reception

The new patient has arrived in a carrier they love, unstressed by the trip to the clinic, so aim to continue this success. Cats feel insecure if they are placed on the floor, so all clinics should have a clearly identified area in the reception away from dogs and other cats where the carrier can be rested off the ground – ideally 48 inches/120 cm or more from the floor. Cats like to be high up, so they can look down on the world, and kittens are no exception (Figure 2). Towels that have been pre-treated with synthetic pheromones should be readily available to partially cover the carrier if not already done by the client; providing the towels in a basket – very similar to a spa – with an educative but inviting sign is a cute idea and is extremely well received by owners. Such touches demonstrate the team’s deep commitment to the feline patient. 

Surprisingly, many clinics appear to be focused on dogs. It is advisable for the veterinary team to enter the practice by the client’s route and look at the reception area and examination rooms; does the clinic and the staff give the appearance to a new cat parent that everyone loves cats? The clinic’s front office and examination rooms should convey this message by ensuring that cats are at least as well represented as dogs in terms of educational materials and merchandise (e.g., cat toys, carriers and collars) (Figure 3). Obviously, this is for the benefit of the client and not the cat, but the clinic and the team have to win over the owner in order to care for the feline patient. Being “Cat Centric”, where it’s all about the kitten and client is critical. Even the artwork on the walls should be tipped towards the feline species – although it is recommended to avoid pictures of real cats that can be seen from the examination table or carrier rest, as this has been known to trigger a negative reaction in some cats; art deco and abstract type pictures are to be preferred.

Starting the consult

Ideally, it is a good idea to get the kitten into an examination room as quickly as possible, partly as reception areas tend to be busy and noisy. “Feline Only” examination rooms are ideal and should include a pheromone diffuser. The carrier should be placed on the floor or a low bench and opened, with the kitten encouraged to come out on its own. Treats, food and toys just outside the carrier are helpful. The author also likes to have an industrial-grade mat in the examination room; because cats are control freaks, a mat gives the kitten traction and security, and allows the pet to play while the clinician acquires the history before starting the examination (Figure 4).

If the kitten is shy and has decided to remain in the carrier, the lid can be removed or unzipped, allowing the kitten to remain sitting securely in the bottom half. Most kittens at this point will decide to explore, but care should be taken if this is done on the examination table. Ensure the kitten does not jump down, which could lead to injury; rather be sure to assist him or her gently onto the floor. The kitten should be allowed to roam the room freely and chase and play with toys prior to the examination, and if there is more than one kitten, they should all be able to make themselves at home in the examination room together. Cats and kittens need to feel that they “own the examination room” and are “in charge” of the appointment. Giving them the opportunity to play and to mark the room with their own facial pheromones by rubbing up against the table, the corners, the cabinets – and even the veterinarian – is ideal. There should also be a place to hide, as some kittens are shy; the lid of the carrier or pet tents are ideal for this purpose. Referring to the kitten by their name and correct gender are critical and necessary for the continued success of the client/patient relationship.

The examination

The examination room should be equipped with everything the clinician needs for the appointment readily available, but should also be fun and educative. Cat scales or pediatric scales should be on the table or floor for easy and accurate measurement of weight (Figure 5). The consult table should be covered with a thick blanket or towel, which will give the kitten security and traction, with a yoga mat or rubber bathmat laid underneath to keep it in place. Remember, even kittens are control freaks; slipping on a stainless steel or laminate table is a frightening experience for the feline species. Ideally pheromone diffusers will be in the room, but if not available the table covering can be sprayed prior to the appointment to help keep the kitten at ease. The towel or blanket can of course also be useful to gently wrap the kitten if it is fidgety or nervous; after the visit, the mat and table can be disinfected, and the towel or blanket put for laundry.

Normally, the author works through an assessment checklist in her head, but the kitten is allowed to roam freely, and the examination itself often occurs in multiple locations throughout the room – on the mat or countertop, the examination table, windowsill, climbers or wherever the kitten is most comfortable.

All the necessary vaccinations, deworming and retrovirus testing can be done in this way – the kitten controls where and how the examination proceeds. The Cat Healthy Preventive Healthcare Protocols, and in particular the Cat Healthy Simplified Protocols, are an excellent reference for the healthcare requirements of kittens in their first year of life*.

* https://www.cathealthy.ca/

Gentle handling of the kitten is very important, with all procedures done on a previously pheromone sprayed blanket with the distraction of treats, canned food and sometimes toys. Move slowly and quietly, as “less is always more”. Kittens, like children, have a short attention span, so do one procedure at a time with a short playtime in between. It is critical that both the kitten and the client have an excellent experience. So for example, when vaccinating kittens, use a new sterile 25G needle and inject in one of the AAFP recommended designated locations. As the injection is being administered, have an assistant gently steady the kitten while offering a treat or small amount of food in a little dish or a thumb depressor. If well distracted, the injection will go unnoticed by most kittens, and the client will be thrilled. All kittens can receive a nail trim at each visit, with the clients being taught and encouraged to do this routinely at home. Lastly, constant interruptions by team members must be avoided – personnel going in and out of the room will stop the kitten relaxing.

Educating kitten owners

The foundation for success begins with good communication and education, and the consult room is also an opportunity to create discussion topics with the client. For example, using food and other treats is a perfect time to discuss the importance of nutrition, and clients are often surprised that kittens and adult cats can have wet food as a major part of their daily diet. The author finds that these casual educative discussions during the appointment, as the kitten is playing, results in a lifetime of compliance, as clients are keen, excited and willing to commit to a future with their new family feline. However, the discussions should be structured. New kitten owners will usually have a long list of questions, often partly due to receiving confusing and conflicting advice from shelters, breeders, the internet, rescue groups, friends and neighbors, so the veterinary team needs to be flexible and answer the client’s priority questions first, but at the same time break through the clutter with a list of topics that should be covered at some point during the planned kitten visits.

A master list of topics is ideal so that nothing is omitted, and each appointment can cover different aspects. It can help to signpost what the owner can expect to cover at the next visit. For example, educating the keen new owner about teething, and mentioning that their kitten has 26 baby teeth which will soon be replaced with permanent dentition, starts the discussion about the importance of dental hygiene. It is very important that a cat owner understands the environmental needs of kittens and cats, so discuss types and locations of scratching posts, water bowls, sleeping areas, playtime and feeding times, and well as litterbox location, types, numbers and hygiene. Playtime is an environmental need for each feline. Encouraging clients to start using treats for training is very rewarding, and they will often come in on subsequent visits proudly showing their kitten “high fiving” or other tricks. Always remember to advise owners that no more than 10% of the kitten’s diet should be treats, and to check the calorie count as well. Recommendations as to “Putting the Hunt in Mealtime” by using feeding puzzles and games of fetch are best started during kittenhood.

In addition to the welcome letter sent prior to the appointment, it is nice to send every kitten home with a welcome package. This can contain additional information and brochures, along with a report card or checklist of what was done at that visit and what still needs to be completed. Add the toy that the cat played with in the examination room – crinkle balls or similar are ideal – and other appropriate items. The team can have fun creating “gift bags” using various things such as breakaway collars, plastic fridge lids for canned food, treats, feeding puzzles, little blankets and suchlike, many of which are often donated by industry partners for this purpose.

As the kitten develops, health plans should be devised to prepare for the transition to adulthood. This will include a schedule for preventive broad spectrum parasiticides, and information as to what vaccinations and adult cat will require for the following and consecutive years. Closely monitoring the pet’s weight and body condition at each visit and sharing your findings with advice on what to feed now, what to feed as the cat gets older, and how much to feed, will be well received, and it is important not to neglect this topic at the spay/neuter discharge, which is an ideal time to reinforce the nutritional recommendations and advise the owner that this operation reduces the cat’s metabolic requirements by 25-30%.

Conclusion

The kitten life stage is the veterinary team’s opportunity to educate the client and to lay the foundation for a lifetime of preventive healthcare. It is also a fun and gratifying time for the team, so embrace and enjoy this experience. Cat clients are often not like dog clients; as with cats themselves, it is necessary to work hard to win their trust and gain their compliance. However, like cats, once you have won their trust and respect, it is in most cases yours forever.