An understanding of the cat and its ancestors helps us to better appreciate why the cat may react negatively at the veterinary practice. The earliest known ancestors of the cat family, Felidae, date back 35 million years.14 Of the 37 species of cats living today, the domestic cat is the only one that is not considered threatened or endangered by conservation organizations. All Felidae are hunters and carnivores. Except for the lion, they are solitary hunters that must sustain themselves solely on what they capture. This includes the so-called “domestic cat” surviving on the frequent small prey that they hunt and capture on their own. The cat is essentially a solitary survivor.

The adage of “a cat is not a small dog” holds true from the time of domestication of dogs and cats. The dog descended from the grey wolf 13,000 to 17,000 years ago, a time when humans were hunter-gatherers, and dogs first assisted with hunting, guarding, and other utilitarian activities. The domestic cat, whose scientific name is Felis silvestris catus, descended from the North African wildcat, Felis silvestris libyca (Fig. 1.1) in the Fertile Crescent about 10,000 years ago with the development of small settlements and the ability to store grains.¹⁵ Grain storage attracted the house mouse, which subsequently attracted cats that were more tolerant of people, leading to a mutualistic relationship between cats and people that required no change to the cat’s normal behavior.¹⁶ Thus cats retain many aspects of their wild predecessors.

There are those who think that the domestication of the cat is not yet complete, and that Felis silvestris catus is just a subspecies of Felis silvestris lybica.^15,18 Genetic analysis has demonstrated that the genotypes of the domestic cat are indistinguishable from that of Felis silvestris lybica,¹⁴ and it is known that they can interbreed. Felis silvestris catus can continue to survive independently, as seen with feral cats that are not fed by humans.

As solitary survivors, cats have amazing athletic abilities and keen senses to allow them to hunt successfully. They have also developed excellent protective mechanisms, including territoriality and the ability to sense and avoid danger. Their emotions and behavioral responses (e.g., their heightened fear response) function to protect them when threatened (see “How cats respond to stressors: the emotional response”). Like their wild ancestors, they hide illness and pain as a protective mechanism, which adds to the mistaken impression that cats are independent and require little or no care. Recognizing these traits aids in understanding how to work with cats within the veterinary hospital.

As solitary hunters and survivors, safe territory is critical to the cat’s survival and more important than relationships with other cats or anything else!17 Safe territory protects against predators and other dangers and provides the resources that the cat requires. Territory gives the cat a sense of control, security in familiarity and predictability, enhancing the cat’s ability to cope.¹⁹ Most cat communication, such as marking, is meant to protect territory without physical interactions and potential conflict with another cat. Leaving their territory or having unfamiliar people or events within their territory can be highly threatening to the cat, causing a loss of sense of control. The complexity of the territory is more important than size, and this can be simulated in the practice by providing a safe place (see “A place to hide”). Providing a safe place enhances the cat’s ability to cope in the veterinary practice.

The cat is the youngest of the species to be domesticated and the only one whose social structure is derived from a solitary survivor rather than a pack animal.1 In fact, the cat is the only domestic animal that is solitary in the wild but with the potential to be social with domestication.^1,20

The cat’s social structure is flexible, with free-living (e.g., feral) cats choosing to live in social groups or colonies only if sufficient food resources and territory exist.²¹ The social organization of the colony is based on females, usually related, cooperatively nursing and rearing the young.²¹

Males leave the colony when mature, but females may remain in the colony if sufficient resources are present. Colonies are quite insular, and strangers are generally not welcome and will be driven away. If a new cat persists in visiting the colony, it may eventually be integrated into the group, but the process often takes several weeks. As cats feel threatened by unfamiliar cats, introduction of a new cat into a household should be done gradually. Also, cats in the veterinary practice should not have exposure to unfamiliar cats.

Within a colony, cats may choose preferred associates or affiliates, which are usually related cats. These cats show affection toward each other through affiliative behavior, described under “Tactile communication.”

Although social, cats are solitary hunters. They catch small prey and may need to eat as many as 20 times each day, with many of their hunting expeditions being unsuccessful. Because cats are solitary hunters, they need to maintain their physical health and avoid fights with other cats whenever possible. Much of feline communication is intended to prevent altercations over food and territory, and thus to avoid the risks of active fighting. Cats also communicate with people and if we recognize their communications, aggression can often be avoided.

The sensitive period of socialization is the age range during which events are especially likely to have long-term effects on the individual’s development. In kittens, the sensitive period is between 2 to 7 weeks of age, perhaps extending to 9 weeks.35 In comparison, the sensitive period in dogs lasts until 16 weeks. Kittens that have positive handling experiences during this period are more resistant to stressors, display less fear, and can learn some tasks faster than cats that are not handled.^36,37 Early enrichment and positive exposures to a wide variety of stimuli, especially those that cats are more likely to encounter during their lifetime (e.g., car travel, veterinary visits, children, other cats, dogs, vacuum cleaners) means the kitten (and later, the cat) will perceive these experiences as comfortable and even pleasant. Veterinarians should encourage clients to expose the kitten to positive experiences, including people of different ages and sexes.

Conversely, if the parents have never been socialized to and fear people, and the kitten has had no positive exposure to people (i.e., a cat that is truly feral), the cat is likely to be extremely fearful of every new person and experience and sees everything surrounding the veterinary visit as a potential threat. Our feline patients have different levels of exposure to people, and some have had very negative previous experiences, such as the kitten that was dumped on the side of the freeway. Also, what is distressing for one cat may not be distressing for another.

Kittens are excellent observational learners. This characteristic likely developed evolutionarily, because kittens learn from the queen how to kill prey.38 Kittens learn quickly by observing an adult cat, generally the queen, performing a task before they attempt it. Thus, if an adult cat in the household is especially fearful at the veterinary practice, scheduling separate appointments for the kitten is ideal. On the other hand, if an unsocialized kitten is bonded to a well-socialized adult cat, it often helps to have them come together (Fig. 1.4).

The cat’s long-term memory appears to be highly developed.39,40 Consequently, we can influence what cats learn by affecting their experiences. For example, if a cat has a painful experience during the first veterinary visit, it will almost certainly be anxious during subsequent visits. In contrast, if the cat learns that the carrier, car trip, and veterinary visit are associated with treats and other positive experiences, the cat learns to enjoy the experience.

People generally focus on preventing undesired behavior rather than rewarding desired behavior. Punishment increases negative emotions and the potential for aggression.⁴¹ Verbal or physical punishment should never be used with cats. Instead, because a cat’s memory of negative experiences can exacerbate future experiences, chemical restraint early on is preferred to physical restraint (see “Anxiolytic drugs, nutraceuticals, and more”).

It is important to teach team members and clients that positively reinforcing desired behavior is the most effective way to teach a cat, and that unwanted behavior should be ignored or redirected to a desirable behavior. Desirable behavior is being calm, playing, purring, and accepting gentle handling. Positive reinforcement must be given within 3 seconds of the desired behavior so that the cat has no opportunity to engage in another activity that we might inadvertently reward instead. At the veterinary hospital, the cat should be rewarded with palatable treats and praise for calm behavior, and treats should also be used to enhance the experience.

A common misconception is that cats cannot be trained; in fact, they enjoy the interactions of training, and can learn to “sit,” “come,” and follow other commands. Training can help cats feel more comfortable and prevent reactivity in the veterinary practice. Most helpful is training the cat to go into the carrier at home, preventing negative associations with the carrier. Positive reinforcement to accept home maintenance procedures such as teeth brushing and grooming can further help to make handling at the practice more familiar.

Cats use a range of subtle body postures, facial expressions, and tail positions to communicate with other cats to diffuse tension and avoid physical contact. While body postures effectively signal a cat’s negative emotions and are more readily detected from a distance, it is facial signals that change much more quickly and provide more immediate indications of a cat’s negative emotions.47 Ears are erect when the cat is alert and focusing on a stimulus, and swivel downward or sideways with negative emotions. Pupils will dilate or become oblong with fear and other negative emotions.

Other eye communications are also important to recognize. Although a cat’s rapid blinking is associated with negative emotions,⁴⁷ in the author’s experience, when a person directs slow blinking toward a cat, it often leads to a responding slow blink from the cat and reduced body tension. Staring, especially by an unknown cat or human, constitutes a threat to cats. Veterinary team members should be taught to avoid staring to make the veterinary visit less stressful for the cat.

The cat’s tail is remarkably expressive. When the tail is held up vertically or wrapped, it signals relaxed, friendly intentions. The cat holds its tail down or lashes it from side to side when fearful or during conflict. If this signal is unheeded, the cat’s behavior can escalate to aggression.

Understanding body postures enables us to recognize and compare calm behavior versus negative emotional responses. Recognizing body and facial posturing associated with the different negative emotions (see “How cats respond to stressors: the emotional response”) allows us to develop a handling plan that helps prevent escalation of emotions and human injury (see “Handling cats with negative emotions differentiated by the behavioral response”).

Threat vocalizations are meant to distance cats from one another. They occur with distress in the practice, where the purpose is to keep humans at a distance. Threat vocalizations include hissing, shrieking, and yowling. The mouth is held open during threat vocalizations as opposed to a closed mouth or an opening and closing of the mouth in friendly vocalizations.48

Cats usually reserve tactile communication for members of their feline social group.49 It functions to solidify the social bond with affiliates through allorubbing (rubbing against one another), allogrooming (grooming each other), and other types of positive touch such as nose touching, sleeping together or one on top of another, and playing together.⁴⁹ Allogrooming occurs primarily on the head and neck (Fig. 1.5 and Video 1.1).⁴⁹ More specifically, the peri-oral (cheek and chin) and temporal (between the eyes and ears) gland sites are used in both scent and tactile communication in affiliate cats (Fig. 1.6).³² Two studies have demonstrated that the peri-oral and temporal gland sites are preferred areas for human touch as well.^32,50 See “Handling to prevent negative emotions” for more information.

In addition to diagnosis of pain and illness, the recognition and management of patient distress is paramount. As with a medical problem, clinical signs can be identified that help us diagnose the underlying problem. Recognizing the signs of distress—for this chapter, acute distress—aids in the diagnosis of the mental health state of our patient. Not only is it important for the welfare of the patient during the appointment but asking owners about these signs at home, which are often subtle and difficult for the owner to recognize, aids in our diagnosis of chronic distress. The link between distress and disease is now recognized in people and other animals, and an understanding of the behaviors associated with emotional responses is the cornerstone of good feline practice.54

We can also recognize feline distress and the subsequent negative emotions as changes to physiologic parameters in healthy cats, necessitating the ability to differentiate between distress and disease.

Acute distress can lead to the following examination abnormalities: tachycardia, increased respiratory rate, dilated pupils, and hyperthermia.5 Healthy but distressed cats may also pant or hyperventilate. Dynamic heart murmurs (most commonly due to right ventricular outflow tract obstruction) associated with stress or pain, but not cardiac disease, can occur in cats. Typically, as the heart rate decreases, and the cat becomes calmer, the murmur disappears. Persistent heart murmurs should be investigated.⁶³ Gastrointestinal or urinary signs may also be seen with a cat evacuating anal sacs, bladder and/or bowel contents. Colitis may also occur.

Diagnostic test results can also be markedly abnormal in a healthy cat. “White-coat hypertension” is a temporary physiologic response to acute distress in a healthy cat.⁵ Hyperglycemia is another such response, with a rapid increase in blood glucose levels to as high as 285 mg/dL (15.8 mmol/L) possible, with or without glucosuria.⁶⁴ The effect may be more pronounced in sick cats, with stress-induced blood glucose levels as high as 1080 mg/dL (60 mmol/L).⁶⁵ Stress hyperglycemia is associated with patient struggling and can last for 90 to 120 minutes.⁶⁴ A mistaken diagnosis of diabetes mellitus can lead to owner stress, a possible decision to euthanize the cat, or provision of insulin therapy and subsequent hypoglycemic crisis. Another common blood chemistry abnormality is hypokalemia caused by epinephrine release.⁶⁶

Complete blood count changes associated with epinephrine release include platelet hypersensitivity, lymphocytosis, and neutrophilia.⁶⁷ A higher concentration of circulating erythrocytes has been shown to occur in conscious healthy cats secondary to restraint and blood collection.⁶⁸ Hyperventilation can lead to alkaline urine.⁶⁹ Box 1.5 lists exam and diagnostic findings that can be affected by acute distress.