Is Your Cat Hiding Pain? Find Out Now!

Discover the hidden signs of pain in cats and learn how to recognize arthritis in your feline friend. In this episode, Dr. Sugerman and Dr. Černá dive into the subtle behaviors that could indicate your cat is suffering. From identifying changes in routine to understanding treatment options like Solensia, this is a must-listen for every cat owner who wants to keep their pet healthy and pain-free. 

In this episode you will learn:

• How to identify subtle signs of pain in cats
• The differences in pain expression between cats, dogs, and humans
• Key symptoms of arthritis and degenerative joint disease in cats
• Effective pain management strategies for feline arthritis
• The benefits and side effects of using Solensia for cats
• Environmental modifications to improve comfort for arthritic cats
• The importance of early detection and treatment of feline pain
• The role of breed and weight in a cat's risk of developing arthritis

Resources:
Crazy Cat Vet Website
Dr. Petra Černá's Instagram

Transcript

Dr. Sugerman: 0:01

Hi, everybody. Welcome back to another episode of Vetsplanation. I am your host, Dr. Sugerman, and we have with us again our Crazy Cat Vet. Thank you again, Dr. Černá, for joining us today.

Dr. Cerna: 0:11

Thank you so much for having me here today again. I'm very excited to be here.

Dr. Sugerman: 0:15

Absolutely. So we're going to be talking today about pain in cats, and then somewhat of a related topic, we're going to talk about arthritis in cats. So we'll start out with just with pain because I feel like with people, we're very dramatic, right? Compared to an animal, we're very dramatic about our pain. Even dogs I feel like are a little bit dramatic sometimes, especially like huskies. I love them, but they'll, anytime they stub their toe, they're screaming. Cats are just not the same. It is really hard to tell if a cat's in pain, even for us as a veterinarian. So can you describe to me, like, how can we tell if our cat is in pain?

Dr. Cerna: 0:52

Yeah absolutely. I think that's, you know, a huge difference between, like you said, humans. So my grandma always used to say that the deadly disease of men is cold. So every time like grandpa would have a cold, it would be really bad. And then dogs, I feel like we can really tell, but cats, what I always, when I look at cats, I always consider them in nature. They would be both predators, but also preys. So they are of course, amazing hunters and, but they also are preys. And therefore they really try to hide often when they are in pain or when they're vulnerable, because of course that would just put the other predators potentially at more tempted to want to hunt them.

Dr. Sugerman: 1:36

Yeah. They're very unique in that way.

Dr. Cerna: 1:37

Absolutely. Cats just they are very, very brave creatures. They have nine lives. I strongly believe in that.

Dr. Sugerman: 1:44

Yeah.

Dr. Cerna: 1:45

The things I have seen cats pull through, I don't think anybody else could, but they're definitely trying to hide pain, which is a big problem for us as doctors, of course, veterinarians because we are struggling and clients as well, the caregivers of cats, they really struggle to recognizing that their cat is in pain and they need to bring them in.

Dr. Sugerman: 2:06

Yeah.

Dr. Cerna: 2:08

Yeah. So the main signs I think to look for really is I, for example, think it can be as subtle as literally just a tiniest change in a behavioral of the cat. So for example, my, the love of my life, Belina, she sleeps with me literally on my neck, behind my head every single night. And then one night she just wasn't there. And I was like, Oh, that's so weird. I wonder, what's going on with Belina. And then I went downstairs in the morning to make my coffee as always. And. She just wasn't looking right. And I looked at her and then she had a horrible cat bite abscess actually, because she was in a fight with one of my cats the day before, which was horrible and that cat no longer lives with us, but yeah he has a great new home with one of my friends because they just were not getting on well. But yeah, so it could be as subtle as a tiniest change in their behavior all, all the way to then, of course, eating a little bit less potentially they can be seeking less attention usually. Usually they wouldn't be like looking for attention more. Sometimes that can happen too, but most of the times it could be hiding, trying to sleep a little more, potentially eating less as well, and just not doing their routine stuff.

Dr. Sugerman: 3:27

So isolating themselves more than they normally would, right? I feel like that's probably one of the top things that people bring their cat in for when there's just, there's no other signs, there's not vomiting or anything. They'll bring them in and just say, they're just not acting right. They just, they didn't sleep with me tonight, or they're hiding in a weird place that they've never been before.

Dr. Cerna: 3:46

Yeah. Cats love their routine stuff. So I know, when I come home, I know various, I have six cats and I know where is the favorite spot of each of my cats to sleep, to rest, when they eat, when they don't eat. So it's just, cats they love their routine stuff. That's why I love them so much because, they don't like changes. So when something they are, changing their routine, there's definitely something going on with them.

Dr. Sugerman: 4:09

And do cats cry out in pain?

Dr. Cerna: 4:12

It's a great question. They definitely potentially could be meowing and be more vocal if they're in pain, but they definitely are not usually yelping like dogs would be. Every time you, and you work in an ER, so you probably see a lot of those dogs with pancreatitis and a lot of other issues or broken bones and they come in and they will be yelping and really showing how painful they are. And, cats just don't really do that. They can maybe be like trying to meow and show us that they might be something going on, but most of the time they don't. Cats can actually interestingly purr when they're in pain. So purring is one of my favorite sounds in cats, but cats can unfortunately purr also when they're in pain. And that's always very sad purr.

Dr. Sugerman: 4:58

Yeah, I did a whole podcast on like why cats purr and one of the things was talking about how they're purring to like self soothe themselves or even potentially to try to heal themselves with purring just because of like the the sound wave that it, that it comes in as, which is really cool. But a lot of people would mistake that.

Dr. Cerna: 5:15

Yeah, exactly.

Dr. Sugerman: 5:17

And they must be happy, not in pain.

Dr. Cerna: 5:20

Yes. And they put a very often also because I breed cats, so when they give birth, when they have those contractions, they really are trying to like breathe through them. And I think that's really helpful. Like you mentioned, those like waves and stuff, I think with potentially really helps them with that pain in during labor.

Dr. Sugerman: 5:36

Yeah, yeah, so amazing what they do,

Dr. Cerna: 5:39

Yes, they are the best creatures.

Dr. Sugerman: 5:41

Right? And you were talking about are they vocal when they're in pain? I will say like one of the top things that I see them vocalizing or just screaming for is when they have the aortic thromboembolism or saddle thrombus where they like have a blood clot that goes to the back legs. And for blocked cats who have urinary obstructions, those are the two things that I think I've ever heard a cat screaming for. Even broken bones, they are going to try to walk on it.

Dr. Cerna: 6:07

Yes, I was just about to say that actually, the thrombo, the aortic thromboembolisms. Those are one of the saddest cases I've had because I think those cats are really just so much in pain. And I think for us vets, it's really important to recognize that and really provide them immediately with some pain relief as well. But I agree. And I think obstructed cats do that as well often, but I feel not always, but the aortic thromboembolism cats, I feel like they always, are crying out loud and that one is probably very painful condition.

Dr. Sugerman: 6:41

Exactly. When you're like, you can break a leg and not be as painful to scream, but like that, those aortic thromboembolisms, they're definitely screaming.

Dr. Cerna: 6:50

Absolutely. Yeah. Like you said, yeah, I see, like lame dogs, it's crying and they

Dr. Sugerman: 6:55

Right.

Dr. Cerna: 6:55

not walk and, cat with a broken pelvis, even, after our, after car accident, they are still like walking around and

Dr. Sugerman: 7:04

Yeah, exactly.

Dr. Cerna: 7:05

Yeah, I always tell people that cats know that they are unfortunately so many creatures, but also humans that do not like them. And they just, want to live despite all those odds. And they just have amazing will to live.

Dr. Sugerman: 7:20

Yep, exactly. When we do recognize that they're in pain, is there any way to comfort them for that pain?

Dr. Cerna: 7:26

Yeah, I think this very much depends what type of pain, of course, this is, because I think if it's an acute pain, those ones, because of all the physiological processes that happen with those inflammatory cytokines, for example, and everything, a lot of these patients really need to be brought in and for us to be able to help them with medications, because a lot of the acute pain can be really quite challenging to manage, I think at home. But for example, then when we go and we'll talk a little bit more about the osteoarthritis in cats, like those chronic pains there, we can actually make environmental changes at home and make modifications and adjustments that can help these cats maybe even improve their needs for needing less pain medications and everything. So I think with the chronic pain. We should really not underestimate it, but I think we could probably do some modifications for them to be able to cope better, especially with osteoarthritis that we will talk about. But I think with that really acute pain, when those cats are not feeling well, I think it's really important to bring them in. Because I, for example, had, because cats can develop and you probably see this a lot in the ER. They can develop the hepatic lipidosis. So these fatty deposits in the liver, if they stop eating, and especially those overweight or big cats, when they stop eating, they start using their fat for energy. And then therefore, of course, they will have these fatty deposits in the liver, which is of course a huge and even life threatening problem for these cats.

Dr. Sugerman: 9:03

I usually tell people, whatever, people are always asking my dog didn't eat for 24 hours. Is that okay? And I'm like, yeah, dogs cannot eat for a week. I'm fine with that. If a cat stops eating for 24 hours, then I'm very concerned.

Dr. Cerna: 9:14

Yeah, I am too. And I actually, one of the worst cases I've ever had of hepatic lipidosis was a cat that it was this two or three year old Maine Coon cat that had a TPLO for her cruciate. And the cat was a little lame before, compensating, doing pretty well. Then she had her, her, her knee surgery. And then the cat was in so much pain and uncomfortable with those plates. The cat stopped eating. Actually developed hepatic lipidosis, became constipated and actually was brought to the vet. And because it was a Maine Coon with unfortunately some ACM, she got fluid overloaded, so then she was in congestive heart failure, we pulled her through it, but that was a horrible complication of a TPLO surgery.

Dr. Sugerman: 9:59

Right, seriously, yeah. I ought to try to fix one, one part that was painful.

Dr. Cerna: 10:03

Yes. And then we cost this whole sequel of problems for her after that.

Dr. Sugerman: 10:08

Poor thing.

Dr. Cerna: 10:09

Yeah. Yeah. So definitely, if you're concerned that your cat isn't acting right, definitely, bring them in because it's an emergency most of the times.

Dr. Sugerman: 10:19

Great. Was there anything else you want to say about pain first before we move on to arthritis?

Dr. Cerna: 10:24

Yeah. I think I would just really try when you bring these cats to the vet, because of course it's first time we see the cat when they come to us, and this from your experience, sometimes for us, it can be really hard because cats can be very stoic to really tell. So I think it's really even the smallest thing potentially can help us, try to. See what might be going on with the pet because I wish I could ask the cats. I wish I spoke cat language and meow. And if there was any way I could learn that I absolutely would. But for

Dr. Sugerman: 10:53

I feel like if anybody could, it would be you.

Dr. Cerna: 10:55

I love that. Yes. I wish, yeah. If I could have one superpower, it would be to speak meow. But yeah, no, I think that would be like really, really important for us to really know just the smallest changes because, we'll do, we'll touch their belly and, dogs with pancreatitis will be super painful. In cats, it's so hard to tell as well. So really important, just always, telling us what you think might be going on or what's happening with your cat, because I think the owners or the caregivers always know their cats the best.

Dr. Sugerman: 11:27

Exactly. And I think also on that point, just making sure whoever does know the cat the best is the person that brings them to the vet. Because sometimes, you'll have a child or somebody who just doesn't do a lot of stuff with the cat. They come in and what's going on? I don't know. It's just not acting right. That's so much harder for us. When they don't give us the signs that we need to when we're doing our physical exam to try to figure out what's going on.

Dr. Cerna: 11:50

Absolutely. Yeah. So please always, and if if most of the times it's always, and again, I am a big feminist and I don't want to be insulting to anyone but always if it's usually like the husband who brings in the cat. We call the wife and he's always like i'm just the driver or the personal taxi driver for the cat you need to talk to my wife. So that always makes me laugh. Oh,

Dr. Sugerman: 12:11

Yeah. Perfect. Anything else about pain in cats?

Dr. Cerna: 12:17

I think we've covered quite a lot of it actually and I think we should maybe talk about the osteoarthritis and actually recognizing also the chronic pain and maybe the management of pain as well in cats.

Dr. Sugerman: 12:30

Perfect. So tell me what is osteoarthritis first?

Dr. Cerna: 12:33

Yeah, so cats, so we call it now more degenerative joint disease because cats can actually have arthritis also in their spine. And so there is also this use of the words. So we probably are a little bit more inclined of using the term degenerative joint disease now, so we can cover the spine as well in these patients. And unfortunately, sometimes as cats get older and we see that in humans as well our joints, of course, are losing the kind of the flexibility there potentially could be a little bit more friction. Sometimes the bones as they touch each other for many years, they can become a little bit more fragile as well. So this, all of these can, and there could be some inflammation in the joints, of course, as well. So all of this can trigger pain in cats and then they can have decreased mobility. So very often what we see in these cats are changes, for example, in jumping up or down. Sometimes these cats are slowing down. They don't want to sleep anymore in their favorite places. So like my cats absolutely love sleeping on their windows and if they do not have an access and they would have to jump really high to go and sleep on those windows, that could definitely be an issue. Sometimes if you pet them on the back, they can be a little bit uncomfortable if you touch them in some area. So definitely noticing that as well. And they usually still eat and otherwise feel okay, but they could be some changes in their appetite as well. But most of it is really, again, those subtle changes of, maybe they don't, I've had a client who told me, you know what, my cat always used to sleep in bed with me and now I have bedroom upstairs and the cat doesn't want to go up the stairs and jump into the bed as she used to because she's sore. So these are all these little things. And then the client was very sad because he lost his wife and he only had that cat. So he was like very upset that, his favorite person almost, our favorite favorite creature in the world doesn't want to be with him at night. And then, so we started medications for the osteoarthritis and then he was just so excited that his cat comes back to bed again.

Dr. Sugerman: 14:46

Good. Good. Nice. Yeah, and with arthritis, it seems like it's a slow progression for people who are really paying attention to all those little tiny details. I feel like sometimes it becomes a very a big thing, like not wanting to jump in the bed when it's progressed pretty, pretty far, right?

Dr. Cerna: 15:05

So it really will start. And I watch because I have a 10 year old cat at home now. So I watch her a lot because sometimes I feel like she is a little bit uncomfortable when I palpate her spine. So we are carefully watching that, assessing that as well. She's a huge pain with taking medication. So I haven't we tried, we did like a Gabapentin trial, but she also has mild allergies, and I've been trying to give her some antihistamines now, and sometimes I just feel like the stress because she's a brachycephalic cat, so she has this smushed face, so every time I try to medicate her, she goes into this little bit of respiratory distress, she really is getting upset, and then, spitting the food all over. And then she doesn't talk to me for a half of the day, but there are always definitely ways we have to find some balance, right? Because sometimes giving cats all these medications, maybe it's not improving their quality of life.

Dr. Sugerman: 16:02

Exactly.

Dr. Cerna: 16:03

Always really need to find that balance there. But yeah, I think just really watching your cats and making sure that they are not any huge changes in their lifestyle is important.

Dr. Sugerman: 16:16

Yeah, exactly. I, randomly I had a cat last week that the guy said that the cat just takes pills and pill pockets because he asked me specifically for pills and not liquids and I was like, what? Your cat is not a cat. I don't, I don't understand. Yeah. That is amazing.

Dr. Cerna: 16:32

No, and I try now like when I breed kittens and stuff, I actually teach them to take like empty capsules in churros and stuff. So we definitely are working on that quite a lot because I think it's really important that cats are really exposed to these treats and, be motivated when they are young. So when they develop these, all these diseases, when they are senior cats, so we have options to give them medication.

Dr. Sugerman: 16:55

Yeah. That's a great idea to do that. Yeah. So are there some cats that are more predisposed to having arthritis than others?

Dr. Cerna: 17:03

We always see it a lot, of course, in domestic short hairs. Absolutely. It's also one of the most common breed of cat, of course, but these large breeds of cats, like Norwegian forest cat, Maine Coons, British short hairs, these cats can even have hip dysplasia, actually, which we don't talk about very often in cats compared to dogs. But I actually was part of my PhD back in Czech Republic. I actually looked at prevalence of hip dysplasia in pedigree cats there. And it was surprisingly really high without the clients not noticing any clinical signs at home. So it really sometimes can be, these signs can just be very subtle. And this only shows us how often we miss these signs at home. And so potentially these like larger breeds. And unfortunately probably the worst breed for this. And I think there are definitely ethical concern about even breeding. This breed are Scottish folds because in Scottish folds, the cartilage defect that makes them have their ears so cutely folded. Is actually a defect in their cartilage and it affects their joints as well. So I have sadly seen a four or five month old kittens that are too painful to jump on a sofa and it's heartbreaking.

Dr. Sugerman: 18:18

Yeah. Ugh. So sad.

Dr. Cerna: 18:20

Yeah.

Dr. Sugerman: 18:21

Yeah. What about if your cat is just overweight, does that predispose them to having arthritis as well?

Dr. Cerna: 18:26

Absolutely. So thank you for bringing that up. Absolutely. Yes. So we always, of course, when I actually just made this big post on my Instagram about feline obesity last week, because of course, unfortunately this is one of the bigger problems and being overweight predisposes you to a lot of different issues and osteoarthritis is one of them.

Dr. Sugerman: 18:47

Exactly. What are some of the best things that we can do to help these cats who do have arthritis at home?

Dr. Cerna: 18:54

Yeah. Environmental modification is very, very important. So I had actually a lot of my clients that build these like huge ramps so the cats can like still go on the windows and I've had one cat that had quite severe osteoarthritis and so they are then wanted to hang out in only one room. So the caregivers brought all of her main resources, right? Like litter box, food, water, toys, bed, and had these like special really, really fluffed cushions for her to sleep in those and everything. So environmental modifications and management for these cats makes a huge difference. Like I have like little, because I have these automatic litter boxes. So now for my, 10 year old, I actually, they sell this little like ramp to it, like

Dr. Sugerman: 19:37

Mm hmm. Yeah.

Dr. Cerna: 19:38

Up into it. So I have those, so it's more comfortable for her to use it. So environmental modification is very, very important, but very often we reach for different pain medications as well.

Dr. Sugerman: 19:52

What about like warming things? I saw like a warming blanket the other day at the pet store and like little warmer beds and stuff for them, what do you think about that?

Dr. Cerna: 20:02

I think they are wonderful, especially in these older cats, because they are also losing muscle mass, so they really are struggling to keep up their body temperature as well. So I absolutely love those. I actually have a heat pad in my bed for myself because I have low blood pressure and I'm always cold and my cats absolutely love it. So they all are using it too. So cats love being warm, right? Like cats really do not enjoy like roaming around and some cats will love to play in snow for a little bit in winter, but they are not like, I want to be by my fireplace. And if you see that, like those pictures of those happy cats that have like their heat pad in front of the fireplace and it's super nice soft bed. I just think with the heat pads, it's really important to make sure they are safe and we should, the cat always should have a choice if they want to use it or not. So we should never just put a heat pad in the bed. So always like making sure maybe half of it is heated and the other one, no.

Dr. Sugerman: 21:00

Yeah, or one one heated and one not heated type thing, right?

Dr. Cerna: 21:04

Yeah, we should always give, give them an option.

Dr. Sugerman: 21:07

We talked we talked before about like we like them to be able to have levels to be able to jump up and down on so do you still do that for your cats who have arthritis or do you just make those levels lower?

Dr. Cerna: 21:17

Exactly. So I still do it for, for the cats with osteoarthritis, but I try to provide options, so for example, if I put those shelves on the wall and even if they want to go higher, I just want to make sure that I put those shelves maybe from lower and very close to each other. So the cat doesn't have to jump too much to get to those. So really providing those kind of, in between steps for them to be able to still go higher because I think cats are really sad when they cannot go high up and all those ramps, like I mentioned before, I really have several clients who build them like these ramps that go from the ground to the window. And then there is a, there is a big pillow or like a big bed for them on the windows as well.

Dr. Sugerman: 21:58

Nice. So I know that not everybody's going to be able to recognize at first that, osteoarthritis in their cats. So how can we diagnose it when they bring them to the vet clinic?

Dr. Cerna: 22:09

Yes, that's super great question. And most of the times, we diagnose them based on our physical exam and like palpation. So when we feel those joints, but radiographs of course, can be very helpful for these patients as well, because we can see some changes on those x rays potentially as well in those joints too.

Dr. Sugerman: 22:29

Yeah, so we're looking for like bony changes a lot of times, right?

Dr. Cerna: 22:33

Yes, exactly. And some inflammation around the joint or soft tissue as well, potentially. I feel like the soft tissue we see more affected with those acute injuries, like broken, for example, bones. But yes, exactly. Those those changes are always great to look for on radiographs.

Dr. Sugerman: 22:50

And so what can we do then in the veterinary field, like what do we do to help with cats who have arthritis?

Dr. Cerna: 22:55

Yeah, there are actually so many pain medications now for cats these days. It can be hard to choose from. And I have to say all of this is always very individual. I've had cats who, opioids like buprenorphine are great for some cats. For some cats, they just do not tolerate them. Cats can have fever, other reactions. They can have hyper salivation, nausea.

Dr. Sugerman: 23:18

Hyper salivation is just drooling by the way.

Dr. Cerna: 23:20

Exactly. Sorry about that. Yeah. So they be

Dr. Sugerman: 23:23

Okay.

Dr. Cerna: 23:23

drooling. My cat, actually Belina. She one time got buprenorphine for cystitis and she goes crazy high on that medication. So she just was walking around all night, meowing, wouldn't rest. So definitely some cats can not tolerate it as well. Then, we have great medications like gabapentin that we use in human medicine, too. And for most cats, it's great. Some cats can really have severe sedation side effect from that. Cats with chronic kidney disease can be more sensitive to it because it gets processed by the kidneys. So we have to be, we have to be careful in those. Non steroidal anti inflammatory medications can be great help because in these joints usually is some inflammation as well. And these non steroidal anti inflammatory medications, they have to break down the process of inflammation and decrease it. But again, in some cats, especially with advanced chronic kidney disease or gastrointestinal upset, these can not be always great. And now we actually have a new drug on the market. That's once a month injection of these monoclonal antibodies. And it seems to really target a specific things in their joints and really be helping with that. And I think that really has changed a, there's been a huge life changer for a lot of my patients with osteoarthritis.

Dr. Sugerman: 24:46

Real quick, going back to the non steroidal anti inflammatories. For everybody who doesn't know, that's NSAIDs. It's typically like us taking ibuprofen, but something that's safe for cats, right? As far as I know, I think there's only two that we can use, right? Onsior and MetaCam

Dr. Cerna: 25:02

Yes.

Dr. Sugerman: 25:03

Can use it.

Dr. Cerna: 25:04

Yeah, this is really actually interesting. So it's only this like black box label in the United States. So it was my number one NSAID to use in cats when I worked in UK. And I used it all the time and long term and then I prescribe it here. And our pharmacy would be calling me and Černá, did you go crazy? And I was like, I just don't see the American cats being so different to the British cats. And so I've actually been using it for a lot of other diseases like cystitis in cats. When I have inflammation. I use sometimes dose reduce. I'm very careful in cats that are not eating, patients that are not well hydrated, but in a otherwise healthy cat, even in senior cat with mild CKD, we now have several studies showing that it's very safe in cats with even a stage one and stage two chronic kidney disease.

Dr. Sugerman: 25:55

Wow. Hopefully they'll change that then so we can use MetaCam and be on label to use for cats. Yeah.

Dr. Cerna: 26:01

Exactly. Yeah. So I think it would be, I think it would be great because Onsior is only also on label for three days. So it's, I think we just need to be careful when we use it, but I've used it even in my own cats chronically. And Belina gets NSAID for after her surgeries and she's a 10 year old cat. And we still use plenty of it too.

Dr. Sugerman: 26:23

Nice. Sorry. Now we'll go back to our injection. So the injection, you said once a month injection, right? It's called Solensia, I want to say?

Dr. Cerna: 26:29

Yes, exactly. Yes, it is called Solensia.

Dr. Sugerman: 26:32

Yeah, I can never remember. So we have one for dogs, we have one for cats, so I always have to go look to see which one is which.

Dr. Cerna: 26:36

Yes, and this was an amazing because actually one of the few drugs that the one for cats came before the one for the dogs.

Dr. Sugerman: 26:45

Oh really? Oh, I didn't know that.

Dr. Cerna: 26:47

Yes. There are not that many drugs. So I always love when there is like a drug that's labeled for cats and we use it off label for dogs. It just makes me so happy.

Dr. Sugerman: 26:56

Because that almost never happens. We always have things that are for dogs that we have to use off label for cats. Cerenia, yeah, really common medication to help with nausea, and it says for dogs only, but we use it for cats all the time. But people get very concerned about it because it says not for cats. Yeah. Yeah, so Solensia injection, so we give it once a month. I've had, so I've had a couple of I've one cat, my own cat that I've used it for, and a couple of my clients that have used it as well for their cats. I did notice that the first injection maybe didn't work as well, but by the second injection you could definitely see a pretty big improvement. Have you seen that as well?

Dr. Cerna: 27:34

Yes, I see in some really huge improvement from day kind of one, but it definitely has happened with several patients where the second dose has been more helpful than the first one. And then we usually try to keep them on regular once a month management as well. There are, of course, some side effects. They are, technically often quite rare. So I've not seen them personally. But some couple of my colleagues have seen, I think the worst one that we see would be some itchiness in these cats. And I've actually had a couple of my colleagues who are feline specialist said that they used like a half a dose instead of a full dose. And then the next time and that has helped and the cats were still comfortable. And I really think that, yeah. And I've had few patients where, we were really considering humane euthanasia for quality of life from their osteoarthritic pain. And then we started them on Solensia started trotting up and down the stairs again. So it was beautiful to see and I think it's definitely worth trying. It's not cheap, however, if you actually think it's just once a month, and then you think, if you have to pill your cat twice a day, and how much those medications cost, it actually comes up almost to the same price.

Dr. Sugerman: 28:47

Yeah, exactly. And do they always, I don't know if you know this or not, do you always have to go into the vet to have the injection done or have you seen people like sell the bottle to, to the

Dr. Cerna: 28:58

Yeah, that's, that's, that's a great question. And I think this one is definitely something that, as veterinarians, we need to be careful about, right? Because actually like humans give themselves injections all the time. So I, I personally am okay with the stress for cats coming in once a month can definitely be high. So as long as my caregivers or my clients are comfortable injecting those cats once a month, and I've had some where they're like, I don't want to do it at home. It, cost X and X and Zed. And if I see. spill it or something happens. Like I don't want that to happen. So they bring the cat once a month, but I've had had several clients where, they treat, they've been caring for cats with chronic kidney disease, they can give subcutaneous fluids at home, they've been giving insulin to their cats. So they have no problem giving these injections at home as well. And, actually I think it's probably for a lot of these probably for a lot of these cats that are stressful and stress going to the vet, going once a month can definitely be challenging. We sometimes do these as a technician appointments. So the technicians just give the injections with the clients in the room and then they go home within five minutes. So we've done that as well.

Dr. Sugerman: 30:12

Yeah, I've definitely had some clients that they, their cat gets really stressed coming in to us and all like that. But now we're at the end of when their injection was working and so they're also more painful and then trying to get them into the carrier. It just becomes a big heart, heartache for both the owner or the pet parent who's like trying to just make them feel better and the cat who's just really stressed out from all of this happening.

Dr. Cerna: 30:34

Exactly. So I think, it's not that difficult to learn to give injections at home. I definitely have many clients who are doing that. So I think I feel comfortable with that.

Dr. Sugerman: 30:45

Nice. Great. Okay. And then so you had said that there are some side effects. Itchiness was the worst. What are some of the other side effects that you've seen?

Dr. Cerna: 30:52

Yeah, I think that's probably like the one where we would see that these cats would really need to stop the medications. It's been, there are, there were safety studies in like chronic kidney disease cats as well. So otherwise the side effects are, are pretty, pretty mild. And I have not really seen many. So main one really would be the skin reactions, like itching, some inflammation, and I think some hair loss has been reported as well.

Dr. Sugerman: 31:19

Is that just in the area where the injection was given or is it itchiness and all over?

Dr. Cerna: 31:24

Actually all over, actually all over. And I think there has been small percentage of cats that have been reported to have some vomiting and diarrhea afterwards. These are always like hard to say, is it actually, because when they actually controlled the, the Solensia to placebo, some of those kids were vomiting too in the study. And I don't, because sometimes just like giving any injection to a cat can make it stressed and throw up or get diarrhea. So I don't think there was like a huge percentage. I think it was like 13 percent of cats that had the Solensia and 10 percent of cats that were in the placebo group. So there wasn't like a really a huge difference between those.

Dr. Sugerman: 32:04

Yeah, and I've also had people who, not with Solensia specifically, but doing flea medication. Somebody had told me that every single time they put the flea medication on, their cat would vomit. We discussed what their procedure was as to how they did it and with the cat licking it afterwards. She's no, I always make sure it doesn't lick it by giving him this can of cat food that it, that they never get. I was like, ah, I

Dr. Cerna: 32:27

Yeah,

Dr. Sugerman: 32:28

Probably a can of cat food that you just gave afterwards that caused an upset stomach.

Dr. Cerna: 32:33

Yeah. No, I know. It's it's, I think it's always hard to say that, we, we've seen this, but I think it's always hard to prove the causality or, I don't know how you would the English term for that.

Dr. Sugerman: 32:44

Yeah. That's right. Yeah. Yeah.

Dr. Cerna: 32:45

Yeah. That this is what it actually cost of vomiting.

Dr. Sugerman: 32:48

Exactly. All right. Any other things you want to talk about for arthritis with our kitties?

Dr. Cerna: 32:54

No, I think we have covered actually a lot of, a lot of things and I am hoping that whoever listens to this, if they have a cat with osteoarthritis at home, they are inspired to make their cat's life better.

Dr. Sugerman: 33:08

Exactly. I think this Solensia injection has been amazing. Oh, I actually did have one other question for you. Sorry. Is there any supplements that you have recommended for arthritis?

Dr. Cerna: 33:19

Really tough question I feel like because we live in a, in a country where supplements are not regulated. So I always tell people, because I have sometimes clients who come to me and they get some 10 supplements and I tell them, I can just mix some sugar and water and start selling it like a magic kitty pill for your cat to live until they're 25 and nobody can even sue me for that. So I think in this, in this country where supplements are not really regulated, not many people actually put their money into the research of actually showing that these supplements work and it's not with all of them, but unfortunately it is with majority of them. And then we actually have not even any control or testing that these sometimes they could even contain like toxic substances, right? Or be contaminated with something. So I personally do not really use supplements very often because I think we just do not have enough evidence that they help and they are not regulated. So I think there are a lot of risks with them actually too.

Dr. Sugerman: 34:23

Yeah, absolutely. Perfect. Thank you.

Dr. Cerna: 34:25

Yeah, absolutely.

Dr. Sugerman: 34:27

Yeah, thank you so much for answering all these questions about arthritis in our kitties and just like how to tell if they're in pain in general. I know you had launched a new website and stuff so I would like to know like how people can get a hold of you now.

Dr. Cerna: 34:38

Oh yeah, thank you so much. Yeah, it's the www.CrazyCatVet.com. So if you want to check my website out, I would very much love that. We've just actually hosted a first conference this year for cat breeders and I am planning a couple webinars actually this later this year on feline endocrinology, some infectious peritonitis as well in cats. And hopefully this kicks off well for the rest of the year. I'm hoping there will be much more happening next year as well. So it's a lot of work, but I'm very excited about this.

Dr. Sugerman: 35:13

You've done a lot just in this year.

Dr. Cerna: 35:15

Yeah.

Dr. Sugerman: 35:17

And then I know you're pretty active on, on Instagram. I think that's the most thing thing you're most active on. Is that right?

Dr. Cerna: 35:23

Yes, yes, I tried. It was my one thing I decided I'm going to push myself out of my comfort zone this year, because I definitely, I'm not a, I hate taking pictures. And so I do not put any pictures there of myself. So don't be, don't be alarmed.

Dr. Sugerman: 35:40

Yeah.

Dr. Cerna: 35:40

I only put videos and pictures of cats and I actually have started posting every Friday. We have a feline Friday. So we talk about some feline medicine disease topics. So last Friday we covered the feline obesity, and I actually am trying to do a lot of feline education to caregivers, but also other vets, so we, people can learn about all the diseases cats can get and what to watch out for at home. So thank you so much for mentioning this.

Dr. Sugerman: 36:08

Yeah. And I know you also have been doing ones with like different cat breeds, which I thought was really cool. Cause then you can just learn about a lot of the different cat breeds, the good things and the bad things, so I think that's super important as well to know what are some of the risks with some of these breeds.

Dr. Cerna: 36:22

Yes. I think it's important too, because I love pedigree cats so much, but I think it's also important that people don't just look at the cat. So this is a cute cat I wanted at home because for example, I think Abyssinian cats and Siamese cats are the cutest cats I know, but with my lifestyle and their needs, because pedigree cats are very, very different breed by breed. And I know Siamese cats are so people dependent. And if I'm not home for 10 hours, like I have my British shorthairs who are completely, perfectly fine being on their own for 10 hours, while a Siamese cat would probably die.

Dr. Sugerman: 36:57

They'd go crazy. Yes.

Dr. Cerna: 36:59

Or not seeing me or, I do not want a crazy bengal at my home, because it's just, I do not have the, I feel like currently I do not have the time to dedicate to a crazy bengal to take him or her out for two hours a day and let them roam there. So I post these, the kind of temperament fun facts about pedigree cats. And yes, also there are a lot of genetic predispositions in these breeds. And so I'm trying to raise an awareness. So when people go and buy a pedigree cat that they know what diseases they might have and they should ask their breeders for testing.

Dr. Sugerman: 37:35

I know for vets. There's also a really cool thing on there too that you'll do a consultation internal medicine consultation for cats as well.

Dr. Cerna: 37:41

Yes, absolutely. If anybody needs any help, I'm always happy to help. I actually gave this FIP webinar last night with, there were over 400 vets there. And I have about 30 emails this morning with consults, so I will have a busy day.

Dr. Sugerman: 37:57

Yeah we'll let you get back to all those emails then yeah.

Dr. Cerna: 38:01

Me. I always love to be being here and talking about cats.

Dr. Sugerman: 38:04

We love, we love having you on so thank you again, dr. Turner, so everybody else You'll make sure to keep your pets happy healthy and safe. Thank you guys

Dr. Cerna: 38:12

Bye.