New tool for fighting feline pain is first in class

Last week, word hit the street that Novartis Animal Health received FDA approval for an oral non-steroidal anti-inflammatory drug (NSAID) for use in cats — the very first such medication for felines.

This is great news. Cats have traditionally been the also-rans in the world of veterinary pharmaceuticals — an afterthought, if thought of at all. I have been a practicing veterinarian for 25 years, and continually frustrated at how few medications get into my hands are approved for use in cats. So my response to this news is, huzzah!

The chemical name of the new drug is robenacoxib, and the trade name is Onsior.

It’s important to understand the context in which this product is approved. From the document in the Federal Register, it is approved for “control of post-operative pain and inflammation associated with orthopedic surgery, ovariohysterectomy, and castration in cats weighing at least 5.5 pounds (2.5 kg) and at least 6 months of age, for up to a maximum of 3 days.”

Always best to start with the precise verbiage associated with the approval of such a product. Looking carefully at the language of this approval, it is a fairly narrow application — an oral formulation, around surgery, only for 3 days, cats must be at least 6 months old and weigh at least 5.5 pounds. The recommended dose is 1 mg/kg given once daily, and Onsior comes in a 6 mg tablet.

From the information I could find, the tablets are not designed to be split, though I need to confirm that detail. Limitations aside, this is the very first oral NSAID made available to veterinarians specifically licensed to use in cats as part of a post-operative pain management regimen.

I’ll take it, restrictions and all.

The licensure process means that we have data demonstrating both efficacy and safety in the target specie (the cat). It also opens the door for ongoing research into using this drug for other painful conditions in the cat such as trauma or wounds, and the biggie, osteoarthritis.

Is this the “magic bullet” for cats? Nope. No such thing. As with any pharmacologic tool in our “pharmatarium,” Onsior demands the same respect as any other NSAID. Common sense cautions for the veterinary practitioner considering this medication include not using this (or any NSAID):

in a cat with GI ulcersat the same time as a corticosteroidwith another NSAIDfor a cat who is dehydratedfor a cat with impaired kidney, heart, or liver function.

These precautions fall into the category of advocating for what is best for the patient, and looking at the condition of the whole patient before making a decision.

Perhaps this approval will open a door for more scrutiny and attention to what else our feline companions need to enhance their health, wellness, and comfort.

What do other cat-lovers think?

Photo credit: Dr. Robin Downing

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The well-adjusted cat: Feline behavior advice from an expert

On Friday, I attended a day long workshop hosted by Dr. Nicholas H. Dodman, BVMS, DACVB, titled The Well Adjusted Cat: Secrets to Understanding Feline Behavior. Dr. Dodman founded the Animal Behavior Clinic at Tufts University Cummings School of Veterinary Medicine in 1986.

The workshop covered the gamut of feline behavior challenges: aggression, fears and anxiety, litter box behavior and furniture scratching, and medical problems that present as behavior issues.

I was particularly interested in the section on feline fear-based conditions, since Allegra is a bit of a fraidy-cat, who, even after more than a year of living with me, is still afraid of any loud and unusual noises outside the house.

I learned that fearfulness in cats is caused by a combination of nature and nurture. Genetics can play a part, with oriental breeds being more prone to fearful behavior. The most sensitive and critical learning period occurs between the age of 2 and 7 weeks, and much harm can be done during this period. According to Dr. Dodman, “kittens that are artificially separated from their mothers much earlier than normal develop a variety of behavioral, emotional and physical abnormalities. They become unusually fearful and aggressive towards other cats and people, show large amounts of random undirected locomotor activity, and learn less well.”

Dr. Dodman recommends treating fears with controlled exposure and counter-conditioning. For example, if a cat is afraid of strangers, try to habituate them to strangers by having the stranger give them treats. For inanimate fears such as thunderstorm anxiety or phobia, provide a safe environment where the cat can feel safe. He also recommends anxiolytic medications or an anxiolytic supplement such as Anxitane.

Feline litter box issues, not surprisingly, took up a large portion of the seminar. Inappropriate urination is the number one issue (along with intercat aggression) he sees at his behavior clinic. As with all other behavioral problems, Dr. Dodman first recommends that the cat get a thorough physical work up to rule out any medical issues. Barring any medical problems, the solution for many litter box problems is to provide an appropriate litter box for the cat. Common owner errors include having too few boxes, in the wrong location, with the wrong type of litter. Frequently, the box is too shallow or too deep. Many cats won’t like covered boxes, and liners or litter mats can cause additional problems. A box that is too dirty can be as much of a problem as a box that is too clean.

The next section covered feline compulsive behavior such as wool sucking, pica, psychogenic alopecia (a displaced excessive grooming behavior) and feline hyperesthesia. Treatment for these conditions will vary for each problem, ranging from addressing the underlying stressors to behavioral and medical treatment. Environmental enrichment and counter-conditioning can help with some of these issues, while others may need medication. Dr. Dodman has had good results with fluoxetine (Prozac) or similar drugs in many of these cases.

The last section of the seminar covered behavioral problems that have medical causes. According to Dr. Dodman, medical underpinnings should always be suspected for a behavior problem, but especially when there is a sudden change in behavior, when the behavior is bizarre or extreme, or when an elderly cat is showing sudden behavior changes. Causes can range from hyperthyroidism to brain tumors and seizures.

One particularly dramatic example was the case of Noah, an adult, formerly normal cat, who began a low growl/moan when his owners were cleaning up their deck one evening. When the owners went into the house to check on Noah, he launched himself at the owner and ripped her clothes and flesh to shreds. The owner ended up leaving the house and leaving Noah alone that night. When she returned the next day, Noah had calmed down some, but was still riled. A month or so later, this happened again, and the owner took Noah to Dr. Dodman’s practice. He was put on anxiolytic medication. He did somewhat better, but weeks later, the owner still couldn’t get near him. Noah was hospitalized and treated with anticonvulsants, and has had no further incidents since. The conclusion was that his rage behavior was caused by a seizure.

Dr. Dodman also addressed feline cognitive dysfunction, a condition very similar to Alzheimer’s in humans. It is typically seen in cats 12 years and older, and is caused by physical changes in the brain. It can be treated with L-Deprenyl, a drug first used in dogs. Dr. Dodman has also had some success with supplements such as CO-Q10 and Acetyl L-Carnitine.

One big takeaway from the workshop for me was that many feline behaviors that we may consider problems are really just normal cat behaviors. They only become a problem when share a living space with these creatures, that, as Jean Burden said, are still “only a whisker away from the wilds.” I believe that it’s up to us as cat owners to provide an environment that honors cats’ natural behaviors and still allows them to be cats. By respecting their unique needs, we only enhance the bond between cat and human.

Photo source: Workhop handout

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I met a feline celebrity in Manhattan

We’ve all heard the saying “Dogs have owners. Cats have staff.” Matilda the Cat has an entire hotel staff at her beck and call.

On a recent trip to New York, I stayed at the famed Algonquin Hotel, which I’d chosen not because of its long history as a haven for writers, but because of Matilda.

The Algonquin, located in the heart of Manhattan’s theater district, has had a resident cat since 1930, when a hungry stray wandered into the hotel in search of food and shelter. Owner Frank Case, famous for first welcoming Dorothy Parker and her friends to start the legendary Algonquin Round Table in the hotel’s bar, welcomed the feline traveler, and a tradition was born.

The current Matilda is the tenth resident cat, and the third cat to be named Matilda. She is a ragdoll who was chosen from North Shore Animal League after Matilda II, a 13-year-old ragdoll, announced her retirement. Matilda III began her residency at the Algonquin about a month ago. She likes to spend time in the hotel’s lobby, behind the front desk, or lounging on a baggage cart. The doormen feed her and the general manager’s executive assistant answers Matilda’s e-mail. When asked whether I could “rent” her for the night to keep me company, the bell captain told me “that would be up to Matilda.”

After spending the afternoon walking around Manhattan, I settled in for some people watching in the hotel’s lounge. Since I don’t drink, I passed on ordering a Matilda (belvedere ponaranza, cointreau, freshly squeezed lemon & orange juice, splash of perrier jouet 18) and stuck with cranberry juice instead. I asked the waiter where Matilda was, and he pointed to a corner of the lobby. And there, underneath a planter, on a velvety cat bed, was the “Algonqueen” herself, snoozing away. Since I didn’t want to interrupt the two guests sitting at the table in front of the planter any more than I already had, I didn’t get a chance to pet her.

Matilda was not out and about when I returned from dinner with friends later that night, and I assumed that meant that she had turned down my request to spend the night in my room.

Early the following morning I went to the lobby in search of coffee, and there was Matilda, stretched out in the very center of the lobby. I bent down to pet her, and was rewarded with a smile, a yawn, and a stretch.

My visit to New York was now complete.

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