urine marking inappropriate defecation inappropriate urination (as means of (for excretion) (for excretion)

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1 Seite 1 von 12 Housesoiling cats and homoeopathy Lecture at the Liga Congress in Budapest, May 15 th, (Dr. Peter Knafl, Wienerstrasse 146, A-400 Klosterneuburg, Austria, tierarzt@knafl.at) I would like to talk to you about house-soiling cats. House-soiling presents the most frequent behavioural disorder with cats seen in veterinary practice. 60 to 70% of the cats with behavioural disorders are taken to see the veterinary because of house-soiling. An estimated 10 % of house-cats show a house-soiling problem once in their life-time. For my dissertation I carried out a comparative study between classical homeopathic treatment and the administration of medroxyprogesterone acetate to house-soiling cats. I would like to present to you the study and the results thereof. To start with I would like to define house-soiling in cats. House-soiling is miction and/or defecation outside the places provided for this purpose by humans, i.e. neither outside the house nor in the cat's litter tray. Inappropriate urine marking also is included in this definition. Therefore house-soiling includes behavior with regard to excretion as well as marking purposes. For practical purposes the annoying excretion behavior was subdivided into inappropriate urination and inappropriate defecation. Furthermore as far as urine marking is concerned a distinction was made between urine spraying and urination as marking behavior. house soiling urine marking inappropriate defecation inappropriate urination (as means of (for excretion) (for excretion) communication) squatting position horizontal position of the tail large amount of urine urine spraying urination as marking behaviour (upright position, (squattting position, vertical position of the tail, small amount of urine at small amount of urine onto socially important places) vertically positioned objects) Inappropriate defecation occurs for excretory purposes. Several authors report that cats within the confines of an apartment also use their excrements as olfactory or optical markings. Inappropriate urination occurs for excretory purposes and not for the purpose of communication. Generally large amounts of urine are deposited near the cat's litter tray or in corners. Urine marking: However urine spraying and urine marking are used as means of communication. They are connected to territorial, sexual and agonistic behaviour patterns. During urine spraying, which occurs with male as well as with female, neutered and uncastrated cats, the animals stand with their stretched pelvic extremities, their tail raised with its tip trembling, and spray a small amount (up to 2 ml) on to vertical objects, 0 to 60 cm above ground, usually at the same prominent places.

2 Seite 2 von 12 If urination serves as marking behaviour, male or female cats in a squatting position excrete a small amount of urine at socially important places. It is often difficult to differentiate between urination as marking behaviour and inappropriate urination for excretion, but with marking behaviour cats keep on using their litter-tray for excretory urination as before and the urine is not excreted at random but at socially prominent places. The connection with territorial, sexual or agonistic behaviour and the possibly smaller amount of urine are a guide-line. Reasons for urine marking: Urine marking is a normal innate behaviour with cats, which will usually be avoided by castration before sexual maturity sets in. Nevertheless it occurs also with neutered male and female cats and will become a problematic behaviour when happening within the home. In this connection scent marks serve as a means of marking its own territory and thus strengthen the self-confidence and well-being of the cat. Urine marking is caused by a disconcertedness in the cat. It is interpreted as an emotional answer to certain conditions or changes like fear, stress or frustration, which take away the cat's sense of security; the cat's own scent is supposed to be reassuring. The disconcertedness in the cat can be caused by social changes in or around the household. Therefore urine marking is attributed to increased irritability. It is also possible that cats acquire the habit of urine marking by learning and behavioural restructuring respectively. They have found that urine marking attracts the attention of their owners or leads to any other reaction they would like to achieve; this will result in more frequent urine marking. Urine spraying also plays an important part in reproduction behaviour informing cats in heat about the location of the male cat. Causes of inappropriate defecation and urination: The following causes for inappropriate defecation and urination outside the cat's litter-tray and factors which can stabilize this behaviour can be mentioned: Preferences for other places or for other scraping material, avoidance of unpleasant scents or attraction to other scents, aversion against the litter-tray itself or its location or the litter respectively, anxiety reactions and/or anxiety conditions. The litter might be soiled too much or the tray is rejected, because it is too small or too enclosed which may lead to an intensification of scents in the tray or the entrance is blocked by fellow cats. A tray that was cleaned too well can also be a reason. A change to a new brand of litter can also start the house-soiling problem. Further causes may be: sleeping, eating and excretory places are arranged too close to each other, too few litter-trays for cats, unpleasant experiences in the litter-tray. Cats in whose cases an imperfect litter-tray management was assumed to be the reason for house-soiling were excluded from the study, as well as those cats in whom organic pathology was the cause. Such organic causes of inappropriate defecation and urination are diseases of the urinary tract (cystitis, urethritis, etc.), the locomotor system, the nervous system, as well as problems in the digestive system.

3 Seite von 12 Therapy: In drug therapy psychopharmaceuticals are administered, most often progestogens are administered to remedy house-soiling. Progestogens are not only effective in treatment of typically male behaviour by inhibiting sexual behaviour but also have an anxiety-relieving, calming effect. Usually depot medroxyprogesterone acetate (MPA) (for subcutaneous or intramuscular injection) or megestrole acetate (to be administered orally) are used. Other anxiolytic drugs like diazepam (1-2,5mg/cat/day) (BEAVER, 1992; COOPER & HART, 1992; HART & HART, 1991; MARDER,1991 a), chlordiazepoxide (HOUPT,1991), alprazolam (HOUPT,1991), buspiron (2,5-5 mg/cat/2x daily)(hart et al., 199;MARDER,1991 a;mertens,1997 b), chlorpromazin (BRUMMER,1997), cyproheptadine (HOUPT & REISNER,1995), clomipramin (MERTENS, 1997 b), acetylpromazine (HOUPT & REISNER, 1995) and amitriptylin HCl (HOUPT & REISNER, 1995; MARDER, 1991 a) are also therapeutically used to remedy house-soiling problems. The therapeutical success is very often insufficient or of a short-term nature only. Therefore the animal is put into an animal home or euthanasia is decided on as a last resort. My study investigates the applicability of classical homeopathic treatment to the housesoiling cat, i.e. to patients whose house-soiling is not due to organic changes. Within the framework of a randomized field-study the therapeutic success of the classical homeopathic treatment is compared to the progestogen treatment - the standard form of therapy in "traditional medicine". Material: The patients used were neutered male and neutered female cats of all breeds, which had been outdoor-cats for a short time only or had been living indoors all the time and were reported to me as having a house-soiling problem. The house-soiling problem had existed for at least one month and during this time occured at least three times a week. Before the onset of the house-soiling problem a period of 1 days during which time the cat was completely housebroken was ascertained. In the anamnesis and clinical examination with special emphasis on the urinary tract any suspected organic cause of the house-soiling was excluded. In case of suspicion of an organic cause urine and blood tests as well as further examinations were initiated. In case of pathological findings cats were excluded from this study. In this study only cats with perfect litter-tray management were included. The following animals were excluded from the study: cats which had not been neutered, cats which spent most of the day and night outside the house or the apartment (outdoor-cats), cats which had not been house-soiling for at least three days of the week during the preceding month, cats which had never been housebroken through a period of at least one month, cats whose house-soiling problem could obviously be attributed to organic changes (e.g. FUS, cystitis, diabetes mellitus, diseases of the urethra, obstructed anal glands, diseases of the prostate, diarrhoea, constipation, diseases of the nervous system and the locomotor system, etc.), cats whose house-soiling problem was due to a faulty litter-tray management,

4 Seite 4 von 12 Method: The method used was a non-blind two-branch randomized therapy comparison in the course of which a traditional homeophathic therapy was compared to a progestogen therapy (standard therapy) and included a first conversation regarding the homeopathic anamnesis. For ethical reasons a placebo group was not used. Now I shall describe the execution of the test: Home visits were made for the anamnesis, clinical examination and therapy. Home visits seemed to be necessary to get more information on the domestic situation of the cat and its owners and about the human-animal relationship, which should be borne in mind when judging this behaviour problem. The keeping conditions of the patients had also to be judged objectively during these home visits. This way statements of the animal owner about the management of the cat's litter-tray could be checked immediately. A homeopathic anamnesis and clinical examination with special emphasis on the urinary tract were carried out. Further examinations as required were initiated in case of suspected organic causes of the house-soiling problem. The places, frequency and conditions of house-soiling as well as the condition of the littertray and the litter were investigated exactly. The aim was to bring out all the individual symptoms and ways of reaction of the animal, to reveal imperfect litter-tray management and to find the cause of house-soiling. This combination of a traditional and a homeopathic anamnesis was carried out equally with all patients and took about one hour on the average. The animal keepers were requested to keep exact records of the house-soiling. They were asked to record in writing the exact date, time, place and type of soiling (urine, excrement, both), as well as special occurrences and suspected causes. Those cats which fulfilled all the criteria mentioned in the chapter "material" and to whom none of the stated reasons for exclusion applied were accepted into the study. These cats were assigned at random to one of the two therapy groups, i.e. already before the home visit the type of therapy (progestogen or homeopathic therapy) was determined for the following four cats that fulfilled all the criteria of this study. If other veterinarians had already carried out a progestogen therapy or a therapy with homeopathic remedies, the cat was automatically assigned to the other therapy group. In cases where there were several cats to be treated for house-soiling in one household, they were treated as one entity as far as the randomisation was concerned, i.e. all of these cats received the same type of therapy (progestogen or homeopathic therapy). This prevented difficulties in judging the success of the therapy in individual animals, difficulties which had to be expected in treating several animals in one household. When there are several house-soiling cats in one household the excrements cannot always be attributed with absolute certainty to a specific cat. Therapy: The administration of progestogens was used as a standard method. Medroxyprogesterone acetate (MPA) in form of the aqueous suspension Perlutex was used. To female cats 50 mg and to male cats 100 mg of medroxyprogesterone acetate were administered subcutaneously once. This corresponds to 2ml Perlutex with female cats and to 4 ml Perlutex with male cats. The repetition of the progestogen administration one month after the beginning of the therapy was determined by the reduction in house-soiling during the first month:

5 Seite 5 von 12 The same amount of Perlutex was administered again if an "insufficient success" (insufficient therapeutic response) in reducing house-soiling (i.e. a reduction of 25-74%) was registered during the first month after the administration of medroxyprogesterone acetate. If the improvement was determined as "success" (therapeutic response with satisfactory results) (i.e. a reduction of %) after the first month, I waited. The therapeutic administration of Perlutex was stopped if the therapy showed "no success" (i.e. a reduction of less than 25 %) after one month; the patient changed to the other therapy group, since the effect of medroxyprogesterone acetate becomes apparent already after the first injection according to HART & HART (1991) and positive results appear within one week according to HART& PEDERSEN (1991). Therefore in these cases I could not count on an improvement of the house-soiling problem one month after the injection. The cats of the second therapy group were treated according to the rules of classical homeopathy. Each patient was treated with the homeopathic remedy which seemed most appropriate to his individual symptoms. This remedy was administered once as high potency medicine. In order not to provoke further variables all remedies were administered as potency M (C 1000). Five globuli of the relevant remedy were administered to the cat per os once. If no effect of the remedy could be ascertained after one month of therapy another appropriate homeopathic remedy was administered to the animal concerned. If necessary the repetition of the administration of the homeopathic remedy took place in monthly intervals according to the rules of classical homeopathy. In order to keep a time limit a maximum of two different homeopathic remedies were administered to one patient during the three months of the study. The homeopathic group of patients were given one subcutaneous injection of Ringer solution (i.e. 2 ml for females, 4 ml for males) in addition to the peroral administration of the homeopathic remedy in order to keep possible influences through therapeutic manipulations constant in both therapy groups. For the same reason the patients of the progestogen group were given 5 globuli per os of placebo in addition to the Perlutex injection. Assessment of the therapeutic success: Every cat owner received printed forms on which he was to record the exact date, time of day, exact place and type of soiling as well as special occurrences and/or the respective assumed cause. The improvement of the house-soiling problem was determined on the basis of the records kept by the cat owners, whereby the frequency of soiling per month after the beginning of the therapy (=X%) was put in relation to the frequency of soiling during the month before the onset of the therapy (=1OO%). Thereby the reduction in the frequency of house-soiling in percent was established and rated as follows: A reduction of at least 75 % in house-soiling or a complete housebrokenness within a month were rated as "success", a reduction from 25 to 74 % was rated as "insufficient success", a reduction of less than 25 % of the frequency of house-soiling within a month in comparison to the frequency before the onset of the therapy was rated as having been "without success". This way, the frequency of house-soiling was ascertained for at least three months after the onset of the therapy. Results: During the test period (September 1996 to February 1998) 129 cats were presented to me because of house-soiling.

6 Seite 6 von cats (2 male and 2 female) fulfilled all criteria of this study. The majority of them were European short-haired cats (46), 5 of them were Persians, there was one Siamese and one Oriental short-haired cat, as well as 2 cross-breeds. With 22 cats (14 male, 8 female) the therapy was begun with medroxyprogesterone acetate (Perlutex ), with (18 male, 15 female) a classical homeopathic treatment was started. The unequal size of the therapy groups was due to the experimental set-up. The therapeutic success achieved by administering medroxyprogesterone acetate to cats which had not initially been treated homeopathically within the framework of this study presents itself as follows: Table. 5: Success with medroxyprogesterone acetate in cats which had initially not been homeopathically treated in days after the beginning of the therapy days after the total without success insufficient succ. success beginning of the therapy * n % n % n % ,5 9 40,9 1 4, , 7 58,4 1 8, ,5 27, 2 18, , 2, 2, ,0 2 40,0 1 20,0 * total number of cats observed at the time (this also applies to the following tables) 0 days after the administration of medroxyprogesterone acetate out of 22 cats the treatment of one cat (4,6 %) was a "success", the treatment of 9 cats (40,9%) an "insufficient success" (compare Table 5). With 9 cats the administration of medroxyprogesterone acetate was repeated after 0 days because of the "insufficient success" during the first month. Of these 9 animals, 4 cats (44,4%) showed "no success" after 60 days, with 5 cats (55,6%) the treatment was rated as having had "insufficient success".

7 Seite 7 von number of cats d. 60 d. 90 d. 120 d. 150 d. time after the beginning of therapy without success insuff success success diagram 4: success with medroxyprogesterone acetate in cats, which had not initially been treated homeopathically, 0, 60, 90, 120 and 150 days after the beginning of therapy It has to be noted that therapeutic success achieved with medroxyprogesterone acetate can be judged meaningfully after 0 days only. After this period of time only cats which showed a positive reaction remained in this therapy group, the other cats changed to the homeopathic therapy group. One can see easily that even in these patients positively filtered out after the 0 th day the rate of success decreases fast as time passes, so that after 90 days out of 22 cats only 2 (2E) were rated with "success" and (T) could only be rated with "insufficient success", which corresponds to a success rate of 9,1% afer months. 8 cats (4T, 4E) were changed after and 4 months respectively because of insufficient success from classical homeopathic therapy to treatment with medroxyprogesterone acetate. 6 of these 8 cats were from households with more than 6 cats. The therapeutic success with medroxyprogesterone acetate was as follows: Table 6: Success with medroxyprogesterone acetate in initially homeopathically treated cats after the beginning of the therapy with MPA days after the total without success insuff. success success beginning of therapy * n % n % n % The results show that animals which were treated homeopathically without success did not show any improvement when treated with medroxyprogesterone acetate (table 6). It was striking that 6 of these 8 cats were from households with more than 6 cats. It turned out that

8 Seite 8 von 12 treatment of animals from multi-cat households with these methods is very difficult; this could be statistically proven after homeopathic therapy. On the other hand about half of the cats which had been initially treated with MPA without success reacted with therapeutic success to the following classical homeopathic therapy, whereby in the beginning success was affected by the initial treatment with MPA for months (table 10 and diagram 9), which I shall explain later. With cats (18T, 15E) a classical homeopathic therapy was started. 2 of these cats were observed for 90 days after the beginning of the homeopathic therapy, one cat was shot after 44 days (after a successful treatment of 4 days) by the owner because of a relapse. The therapeutic success in cats treated with the classical homeopathic therapy, which cats had not initially been treated with medroxyprogesterone acetate within the framework of this study, presents itself as follows: table 8: success with the classical homeopathic therapy in cats, which had initially not been treated with medroxyprogesterone acetate, after the beginning of therapy days after the total without success insufficiant succ. success beginning of therapy * n % n % n % 0 9,1 7 21,2 2 69, ,6 8 25, , , 9, , ,5 12, , ,6 16, , , 1 7, ,6 After 0 days 69,7% of the cats were rated as having been treated successfully and 21,2% were rated as having been treated with insufficient success. In the following months about 59% of the cats were rated as having been treated successfully.

9 Seite 9 von number of cats days time after beginning of therapy without success insuff success success diagram 6: success of classical homeopathic therapy with cats which had initially not been treated with medroxyprogesterone acetate after 0, 60, 90, 120, 150 and 180 days after the beginning of therapy Noteworthy is the continuously decreasing number of necessary monthly treatments of homepathically treated cats, which is depicted in diagram 7. All of the animals were administered a homeopathic remedy on day 0, only 14 of them were treated on day 0 and only 8 of 2 cats were treated on day 60. It is also striking that after therapy on day 0 9 cats stayed housebroken for at least 150 days without an additional administration of the remedy although house-soiling had been going on with 4 cats for already 4 to 9 years. This proves the assumption that by selecting the appropriate homeopathic remedy the positive effect in the sense of a regulatory therapy shows fast and lasts for a long time without the necessity of a repetition of the dose.

10 Seite 10 von 12 5 number of cats and remedies AM-d- 0 success 0 d AM-d-0 success 60 d AM-d-60 success 90 d AM-d-90 succ. 120 d AM-d-12 succ. 150 d n - AM success insuff success without success diagram 7: success of classical homeopathic therapy in cats, which had initially not been treated with medroxyprogesterone acetate, 0, 60, 90, 120 and 150 days after the beginning of therapy compared to the number of homeopathic remedy doses (n-am) administered respectively one month before. The therapeutic success with cats 0 days after the beginning of classical homeopathic therapy differs significantly (p 0,001***) in the Chi-square-test after Pearson from the therapeutic success 0 days after the beginning of treatment with medroxyprogesterone acetate. After the 0 th day the difference in therapeutic success cannot be shown statistically due to the remaining small number of cats treated with medroxyprogesterone acetate. Table 9: success with classical homeopathic therapy (H.) and therapy with medroxyprogesterone acetate (M) in cats, which had initially not been treated, respectively, after the beginning of therapy days after the beginning of therapy H / M total * without success n % insufficiant succ. n % success n % 0 days after H. 9,1 7 21,2 2 69,7 0 days after M ,5 9 40,9 1 4,6 60 days after H ,6 8 25, ,4 60 days after M. 12 4, 7 58,4 1 8, 90 days after H , 9, , 90 days after M ,5 27, 2 18,2 120 days after H ,5 12, ,0 120 days after M. 6 2, 2, 2, 150 days after H ,6 16, ,8 150 days after M ,0 2 40,0 1 20,0

11 Seite 11 von 12 number of cats H M H M H M H. 120 time after beginning of therapy (H. oder M.) M H. 150 without success insufficiant success success M. 150 diagram 8: Comparison of success with classical homeopathic therapy (H.) and therapy with medroxyprogesterone acetate (M.) in initially not treated cats, in days after the beginning of therapy The efficacy of classical homeopathy in house-soiling cats could be definitely proven in this study. In comparison to the therapeutic response of medroxyprogesterone acetate the homeopathic success was significantly better (p 0,0001***), which expressed itself in a success rate of 60% after months for the classical homeopathic therapy. Owing to lacking success (i.e. "without success") of the treatment with medroxyprogesterone acetate 16 cats (11T, 5E) underwent classical homeopathic therapy. table10: success of the classical homeopathic therapy in cats, which had initially been treated with medroxyprogesterone acetate, after the beginning of therapy according to this method days after the beginning total without success insufficient succ. success of therapy * n % n % n % ,7 8 50,0 1 6, , 6 40,0 4 26, ,0 2 1, 7 46, ,4 2 15,4 6 46, ,2 2 22,2 5 55, ,5 2 25,0 5 62,5

12 Seite 12 von 12 number of cats days time after beginning of therapy without success insufficient success success diagram 9: success with classical homeopathic therapy in cats, which had initially been treated with medroxyprogesterone acetate, 0, 60, 90, 120, 150 and 180 days after the beginning of therapy with this method In those animals which had been initially treated with medroxyprogesterone aceatate, the therapeutic success of the classical homeopathic therapy was notably smaller than the success without any such initial treatment. Though the success rate increased continuously within 180 days, which was proved by means of the trend test (compare table 10 and diagram 9). This leads to the conclusion that there is a negative effect of medroxyprogesterone acetate on the efficacy of homeopathic remedies, whereby the slow increase of the therapeutic success can be explained with the long half-life period (45 days) of MPA. Similar facts are reported of corticosteroids which can block homeopathic therapy for months, even when the actual effect of the corticosteroid seems to have long subsided. The number of cats in a household correlates with the success of homeopathic therapy 0 days after its beginning, i.e. the success rate decreases with the growing number of animals in one household. In conclusion I would like to present a short "paragraph" on the therapeutic remedies which to me seem to be very important in treating house-soiling that is not due to organ pathology - including a certain rating. This paragraph is by no means complete, each one of you is called upon to verify and extend it. (44) Acon., ambr., anac., arn., ars., Aur., Bar-c., bell., bry., Calc., calc-p., caps., carc., Caust., cham., chin., coloc., con., gels., graph., Hyos., Ign., kali-p., lac-f., Lach., Lyc., merc., Nat-m., nit-ac., Nux-v., op., ph-ac., Phos., pic-ac., Plat., PULS., sep., STAPH., Stram., sulph., tarent., thuj., verat., zinc. Autor: Dr. Peter Knafl Wienerstrasse 146 A-400 Klosterneuburg Tel.: +4 (0)224/ tierarzt@knafl.at Homepage: