Cat Healthy Protocols

03- Questions to Ask: The Medical History

Open-ended questions (those starting with words such as ‘who’, ‘how’, ‘what’, ‘when’, ‘where’, ‘why’ and where the answer requires a description) are often better than close-ended questions (yes/no answers) for extracting information. If a close-ended question is used to start the conversation, follow it up with an open-ended question. For example, questions such as “Are there any changes in Fluffy’s defecation?” or “Is there anything unusual about Fluffy’s feces?” fail to parse out that Fluffy has chronically had soft/hard stool or that the cat defecates outdoors. An answer of: “No” needs to be followed up with “Please describe Fluffy’s feces.” Specific open-ended questions to ask include:

1. What are your concerns today?

Always start by determining the client’s concerns and goals for the visit. The initial reason for booking the appointment may not be the only important issue on the client’s mind.

2. How much time does your cat spend outside? How much contact does your cat have with other animals?

An important part of risk assessment is determining the cat’s lifestyle. Clients may consider their cat as an indoor pet with a low risk of disease, but with questioning, it may become apparent that the cat travels with the client, goes to a boarding facility, meets other cats in the building, goes on a balcony, etc. This question helps determine which vaccines are warranted. The cat’s origin (e.g., was it adopted after a natural disaster in another region?) and travel history are important parts of the medical history for developing a differential list for illnesses caused by infectious diseases.

Additionally, if the cat lives strictly indoors, questions should be asked to identify areas for possible improvement in meeting environmental needs (see Optimizing an Indoor Lifestyle for Cats in Resources).

3. Who lives with you and your cat? Are there any other pets in the home?

Knowing whether children or immunocompromised people live in, or visit, the home will help assess risk of zoonotic disease. Changes in the composition of the household (e.g., a new baby, a student leaving for college, etc.) can cause stress and even clinical signs of illness.

4. Does your cat ever urinate or defecate in your home outside the litter box?

This is a critically important question that leads to further discussion should the answer be ‘yes.’ All too often, inappropriate elimination is not brought to veterinary attention until it has gone past the point where a client is willing to tolerate it. Early identification allows for appropriate diagnostics and environmental modifications that can avoid frustration, a damaged human-animal bond, and possible relinquishment to a shelter or euthanasia.

5. Have you noticed any changes in your cat’s behaviour or temperament? Do you have any questions or concerns about your cat’s behaviour?

This question should be asked in addition to the previous question. Behaviour problems and problem behaviours are often overlooked in feline medicine and can become a reason for euthanasia which is the main reason for relinquishment to shelters in Canada. People often do not realize that veterinarians can provide behaviour counseling or that many behaviour problems have a medical basis. For example, in senior cats, many changes are wrongly attributed to old age when the causes may be due to disease, pain, or social distress. For more information, see the AAFP Feline Behavior Guidelines and ‘Diagnosing and Solving House-Soiling Behavior in Cats’ (see Resources).

6. Where are the food, water, and litter box(es) located? How many are there?

Determining the number and location of key resources (e.g., food bowls, water bowls, litter boxes, toys, perches, sleeping and resting places) is important for the cat’s quality of life and well-being as well as for assessment of behaviour problems. The required number and location of these key resources are determined by the number of cats in the home, as well as the presence of other pets and perceived threats. Asking the client to draw a floor plan showing the location of key resources can be very helpful. For more information, see the AAFP/ISFM Environmental Needs Guidelines and the ‘Welcome to Cat Parenthood/New Owner Checklist’ (see Resources).

7. What foods does your cat eat? How much do you feed and how often? What kind of treats do you give your cat?

See the section on Nutritional Assessment.

8. Do you have pet insurance for your cat?

Several companies provide different levels of insurance plans for cats. These plans can be very helpful in an emergency or health crisis. Knowing that a proportion of the costs of care are covered by insurance can make diagnostic and treatment planning more feasible for the client.

9. What form of identification does your cat carry?

All cats should have both permanent (e.g., microchip, tattoo) and visual (e.g., tag on a break-away collar) forms of identification. Microchips and tattoos are only useful if the client’s contact information is registered and kept up to date. The veterinary team can remind clients of the need to keep contact information current in relevant databases at each preventive care visit. An ideal time to place a microchip or tattoo is during anesthesia for surgical sterilization or other common procedures such as dentistry, however, microchips can be placed without sedation or general anesthesia. The microchip should be scanned annually to verify placement and function. This is also a good time to ensure that the client’s contact information is up to date in the microchip database.

10. How would you describe your cat’s feces?

As mentioned in the introduction to this section, the stool quality, consistency, quantity, colour, and frequency should be determined for every cat (even if they are not presented for gastrointestinal problems) and recorded in the medical record. Tools such as a fecal score chart are very useful. Several fecal score charts are available from pet food companies; each clinic should select one system that will be used by the healthcare team for consistency. Cats with abnormal fecal scores should have a diagnostic investigation. For example, chronically soft stools may indicate an underlying disease while chronically small, hard stools may be due to dehydration.

Resources

Fecal Scoring Chart (Nestle Purina) – page 13 in Quick Reference Guide:
Diagnosis and Management of Gastrointestinal Disease:
youtube.com/watch?v=wsYg5GeaSHU

Optimizing an Indoor Lifestyle for Cats (Dr. Margie Scherk) in Veterinary Focus, Vol 26(2), 2016:
Available through International Veterinary Information Service (free registration):
ivis.org/journals/vetfocus/26_2/en/toc.asp

AAFP Practice Guidelines (available free):
catvets.com/guidelines/practice-guidelines

  • Diagnosing and Solving House-Soiling Behavior in Cats
  • Environmental Needs
  • Feline Behavior