Chicago Veterinary Medical Association. Shaping the Future of Veterinary Medicine - Promoting the Human-Animal Bond. Proudly Presents: With:

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1 Chicago Veterinary Medical Association Shaping the Future of Veterinary Medicine - Promoting the Human-Animal Bond Proudly Presents: ANIMAL BEHAVIOR With: CHRISTOPHER PACHEL DVM, DACVB Co-Sponsored by: September 2, 2015

2 DO YOU SEE WHAT I SEE: MEDICAL PROBLEMS MASQUERADING AS BEHAVIORAL PROBLEMS Christopher Pachel, DVM Diplomate ACVB Animal Behavior Clinic Portland, Oregon Caveats Not every behavior issue has a medical cause, but some do Justification for the have your pet checked by a vet guideline Not an all-inclusive list, but will be a good starting point Evaluation of differential diagnoses based on presenting behavioral signs List of behaviors/patterns Changes in activity Changes in appetite Housesoiling Aggression Excessive licking Travel/transport problems Episodic, unprovoked behaviors Unexpected behavior change 1

3 Changes in activity Behavioral causes Fear/anxiety Fallout of training method Inappropriate reinforcement Reactivity or excessive arousal Insufficient exercise Changes in activity: Commonly reported signs Limping, lameness, pain Reluctance to jump/weave Worse after rest or exercise Weakness or exercise intolerance Rapid muscle loss Altered mental state Weight gain Decrease in overall energy Agitation or anxiety Restlessness, pacing Changes in activity Musculoskeletal causes Osteoarthritis Tumor or cancer Other (torn CCL, patella luxation) 2

4 Changes in activity Neurological causes Intervertebral disc disease Spinal trauma Degenerative Myelopathy Tumor or cancer Metabolic causes (e.g. portostystemic shunt leading to hepatic encephalopathy) Changes in activity Hormonal causes Thyroid dysfunction (hyper- or hypo-) Secondary to spay/neuter Cushing s disease Addison s disease Changes in appetite Behavioral causes Low palatability of food Owner reinforcement Opportunistic behavior Breed related Fear, anxiety 3

5 Changes in appetite: Commonly reported signs Onset after dietary indiscretion or food change Lethargic, overall decreased activity Changes in stool quality or odor Seems hungry all the time Eating non-food items Changes in appetite Gastrointestinal causes Malabsorption Maldigestion Malnutrition Hunger Nausea Abdominal pain Food hypersensitivity Dental disease Changes in appetite Hormonal causes Associated with estrus cycle Thyroid dysfunction (hypo- or hyper-) Cushing s or Addison s Other sources of pain/discomfort Musculoskeletal Neurological Dermatological 4

6 Housesoiling Behavioral causes Urine marking Incomplete housetraining Breakdown in housetraining Secondary to anxiety conditions Separation anxiety Noise phobia Lack of access to appropriate location or substrate Housesoiling: Commonly reported signs Increased frequency going all the time Urgency to eliminate can t hold it Dilute urine it s like water Change in stool quality or texture Urinating small amounts Blood in excrement Abnormal odor Soiling on resting surfaces Soiling occurs at rest (urine) or while walking (stool) Soiling occurs passively (without active posturing) Housesoiling Urinary tract conditions Urinary tract infection Crystals or stones Renal insufficiency Gastrointestinal tract conditions Secondary to food quality or dietary change Parasite or bacterial overgrowth Inflammatory/irritable bowel Constipation 5

7 Housesoiling Incontinence Sphincter incompetence (urethra, anal/rectal) Hormone responsive (urine only) Secondary to neurologic condition Neurological conditions Seizure disorder Cognitive dysfunction syndrome Altered mentation secondary to metabolic dysfunction Housesoiling Conditions affecting urine concentrating ability Renal insufficiency Liver disease Cushing s disease Diabetes mellitus/insipidus Medication side effect Aggression Behavioral causes Fear, anxiety, defensive Competitive Territorial Redirected Resource guarding Play or arousal related Other functional patterns 6

8 Aggression: Commonly reported signs Aggression associated with handling or contact Onset that correlates with physical illness Changes in mobility, energy, activity, appetite just not himself Unprovoked growling or snapping Aggression Pain or discomfort Arthritis, joint issues Ear infection Pancreatitis or abdominal pain Dental disease Hormonally influenced Intact animals (estrogen, testosterone) Steroid related (Cushing s, Addison s) Thyroid dysfunction Aggression Irritability Itchy skin Sleep deprivation Reactive, highly aroused Medication side effect Secondary to pain or discomfort Cognitive changes 7

9 Excessive licking Behavioral causes Attention seeking Reinforced behavior Self-soothing Displacement behavior Compulsive disorder Excessive licking: Commonly reported signs Excessive licking of surfaces or person Excessive self-directed licking Changes in appetite or stools, gassy Regurgitation, vomiting, burping Eating of non-food items Picky eater Excessive licking Gastrointestinal disorders Esophageal reflux Stomach ulcers Irritable bowel syndrome Pain, discomfort, inflammation Arthritis Allergies Trauma 8

10 Travel/transport problems Behavioral causes Secondary to negative experiences Inappropriate equipment Environmental reactivity Fear, anxiety issues Inexperience Travel/transport problems: Commonly reported signs Panting, pacing, inability to settle Reluctance to load into vehicle Attention seeking behaviors Whining or vocalizing Lip licking, vomiting Travel/transport problems Gastrointestinal causes Inflammatory bowel conditions Motion sickness Nausea Pain or discomfort Arthritis Can happen in young dogs too! Pinched nerve or neurogenic pain Traumatic injury 9

11 Episodic, unprovoked behavior Behavioral causes Resource guarding, conflict related aggression Fear, anxiety, reactivity issues Insufficient owner knowledge or awareness Caveat Disconnect between owner perception of what should be provocative and pet s actual response Most unprovoked behaviors have identifiable provocation when you know what to look for Episodic, unprovoked behavior: Commonly reported signs Completely unprovoked It happens out of nowhere Jeckyl and Hyde Changes in mental status Inconsistent doesn t happen all the time History of lower intensity reactions to individual stimuli (supportive of trigger stacking) Episodic, unprovoked behavior Medical causes Seizure, neurologic problem Hormonal (thyroid, steroid, sexual) Anything that causes irritability (trigger stacking) 10

12 Unexpected behavior change Behavioral causes Normal for developmental period (adolescent ) Learned/reinforced behavior that reaches threshold point of concern Lack of owner knowledge about what is normal or expected Unexpected behavior change Medical causes Pain most common underlying cause Hormonal (thyroid, steroid, sexual) Neurological abnormality (seizure, tumor, CDS) Underlying metabolic problems (Irritable bowel syndrome, hepatic disease, medication side effect) Altered sensory input (vision/hearing loss, hyperesthesia due to skin conditions) Medication side effects Strategies for discussion Respect training and credentials boundaries Empower clients to be advocate for pet Address training or learning component Be professional Always. 11

13 Respect training and credentials boundaries Client permission to relay observations and recommendations to trainer Define best method of communication Phone, , trainer attend appointment with client Direct communication avoid putting client in position to relay information Medication and diagnostic recommendations come from veterinary staff, not the trainer Mutual professional respect Empower client to be advocate Client knows pet better than anyone Strive for partner relationship Okay to push or encourage when needed (compliance, implementation support, etc. ), but maintain respect and professionalism May be necessary to consult with different trainer if current relationship is not a good fit Address training/learning component Even if behavior issue is caused by medical problem, treatment of medical cause may not resolve current problem I can help you with... but we ll need to address the learning/training component too Provide feedback as needed 12

14 Be professional - Always Even when perception of medical, at-home, or training care is poor or suspect Avoid set up for awkward communication Triangle trainer, client, vet Stay within the parameters of your professional role All on same team! Strategies for discussion Respect training and credentials boundaries Empower clients to be advocate for pet Address training or learning component Be professional Always. List of behaviors/patterns Changes in activity Changes in appetite Housesoiling Aggression Excessive licking Travel/transport problems Episodic, unprovoked behaviors Unexpected behavior change 13

15 Thank you! 14

16 BEHAVIORAL EFFECTS OF SPAYING AND NEUTERING Christopher Pachel, DVM Diplomate ACVB Animal Behavior Clinic Portland, Oregon Hierarchy of Scientific Evidence Expression of Behavior Multiple levels of influence Species Breed Individual Gender Age Experience Environment Hormone status 1

17 Expression of Behavior Multiple levels of influence Species Breed Individual Gender Age Experience Environment Hormone status Influence of testosterone Enhancement of male, sexually dimorphic behaviors Dogs exposed to testosterone and displaying inappropriate or out of context behaviors modifier rather than cause of behavior change Decreased latency to react Increased reactivity intensity Longer duration of reactivity Slower recovery after reaction Castration removes that present influence, no impact on learned behaviors Influence of estrogen May have anti-anxiety effects along with oxytocin Role in reproductive cycle Relevant for interdog, irritable, maternal aggression 2

18 General impact of altering Most likely to impact sexually dimorphic behaviors (maternal aggression, intermale aggression, etc.) Rapid decline of testosterone post neutering May not reverse or eliminate behavior patterns caused or influenced by hormones No impact on learning, rehearsal, reinforcement Does age matter? Comparison between dogs altered at <24 weeks and 24 weeks 269 of 635 (42%) of dogs altered during study period Median follow-up period of 48 months No difference: Incidence of behavior problems, rate of retention in home Does age matter? 31 clinically normal kittens Prospective, controlled study Groups neutered at 7 weeks, 7 months, left intact No behavior differences noted in first two groups Intact cats showed greater intraspecies aggression and were less affectionate 3

19 Does age matter? 2505 Vizslas borm between 1992 and 2008 Demographic, gonadectomy status, age at diagnosis of disease/disorder Anonymous online survey Increased odds (4.1 relative risk) of fear of storms for all gonadectomized dogs Increased odds (1.8 relative risk) of behavioral disorder if gonadectomized at 6 months of age (NSF for other ages) Behaviors Interdog aggression Human directed aggression Resource guarding Roaming Urine marking Fear Reactivity Maternal aggression Mounting Territorial aggression Noise phobia Separation anxiety Age related cognitive changes Interdog aggression Neutering often recommended for inter-male aggression Unlikely to make situation worse Removes genes from breeding pool (when appropriate) Spaying variable recommendations/outcome Removes hormonal fluctuation associated with cycle Removes source of competition or arousal for males Estrogen plays lesser role than testosterone in interdog issues 4

20 Interdog aggression Aggression noticeably reduced in 60% of 42 postpubertal dogs after castration (Hopkins 1976) Neutering does not appear to decrease the likelihood of aggression in male dogs, other than perhaps for intermale and territorial aggression (Hart 1997) No effect of neutering on inter-male aggression, roaming, mounting (Mengoli 2010) Human directed aggression Data gathered by owner survey at 6 month intervals 150 dogs in each group (spayed/unspayed) OHE may increase aggression Female dogs less than 1yr Already exhibiting signs of dominance aggression Human directed aggression Data from modified C-BARQ questionnaire (translated) 852 questionnaires Altered dogs were less likely to score above the median for owner directed aggression 5

21 Human directed aggression 3226 questionnaires/dogs Subjects solicited from vet clinics Odds ratio of: F/I M/I F/S M/N Growling Possessive aggression Biting member of household Neutered males Neutered females Intact males Intact females Human directed aggression Comparison of populations in Kingston, Jamaica and San Francisco, CA Interview data for 161 biters and 951 non-biters Relative Risk (RR) for non-play bites: Intact females (3.22) Intact males (2.56) Neutered males (1.52) Neutered females Human directed aggression Incidence likely dependent on factors in addition to spay/neuter status 6

22 Human directed aggression Survey of dogs aged 3-5 years (identify behaviors at/past social maturity) Identify aggression on screening questions, specific description of incident context 1053 dogs total: 494 males (327 intact), 559 females (210 intact) Neutered > Intact males - more aggressive in 14/18 contexts of owner directed aggression Spayed > Intact females more aggressive (10 variables) Spayed/Neutered = more likely to have bitten than intact dogs (no difference in M vs. F bite history overall) *** Neuter status in males was still associated with higher risk of aggression even when 29 male dogs that were neutered because of aggression were removed from the statistical analysis Roaming 42 post-pubertal dogs ~90% of dogs showed rapid or gradual decline in roaming No effect of neutering on inter-male aggression, roaming, mounting (Mengoli 2010) 7

23 Urine marking 42 post-pubertal dogs 50% of dogs showed rapid or gradual decline in urine marking Urine marking 57 male dogs greater than 2yrs at time of neuter Retrospective, interview based information 60% (60-80%) of owners reported improvement at the 50% level, 25-40% improved at 90% level Decrease between 50-90% can be expected for 50-75% of adult male dogs post-castration Urine marking 10% of adult male cats, 5% of adult female cats altered between 6-10 months engage in marking (Hart 1984) Castration eliminates urine marking in 90% of affected adult cats (Hart 1973) 8

24 Fearful behavior Client assessments of 10,839 dogs C-BARQ survey based Unpublished, non-peer reviewed Cause/effect relationship? Neutered dogs are more fearful, excitable, aggressive, and less trainable than intact dogs Farhoody, P., and C. Zink. "Behavioral and physical effects of spaying and neutering domestic dogs (Canis familiaris)." Summary of findings detailed in a Master s thesis submitted to and accepted by Hunter College in May (2010). Fearful behavior 57 male dogs greater than 2yrs at time of neuter Retrospective, interview based information No significant effect on: Fear of inanimate stimuli Aggression toward unfamiliar people Fearful behavior 135 dogs Observed under practice conditions Owner interview and standardized exam No association between castration status and incidence of fearful behavior Age, gender (M>F), and previous experience were correlated with fearful behavior 9

25 Fear and anxiety Questionnaire data 367 respondents 413 dogs in population De-sexed dogs (compared to sexually intact): More timid or nervous Less anxious Engaged in less destructive behavior Reactivity All dogs were anesthetized, 7 were spayed 14 dogs, assessed 4-5 months post surgery only Limited to OHE of 5-10 month old GSDs Spayed female dogs were more reactive to approach of unfamiliar person/dog Mounting 67% showed decrease in mounting 7/8 toward people 1/4 toward other dogs No effect of neutering on inter-male aggression, roaming, mounting (Mengoli 2010) 10

26 Mounting 57 male dogs greater than 2yrs at time of neuter Retrospective, interview based information 60% (60-80%) of owners reported improvement at the 50% level, 25-40% improved at 90% level Decrease between 50-90% can be expected for 50-75% of adult male dogs post-castration Territorial aggression 57 male dogs greater than 2yrs at time of neuter Retrospective, interview based information 10% or fewer dogs showed significant improvement, even at 50% improvement level Noise phobia / Separation anxiety 1842 dogs Questionnaire based data Decreasing age at gonadectomy associated with increased rate of noise phobia Gonadectomy <5.5 months associated with lower frequency of separation anxiety 11

27 Age related cognitive changes 325 dogs older than 9 years Structured phone interviews 22.5% incidence of cognitive changes overall Females and altered dogs were more likely to be affected than males and intact dogs 42.5% of altered females (25.8% intact) 26.3% of altered males (13.4% intact) Age related cognitive changes 139 dogs aged years Two interviews months apart Intact males significantly less likely to progress from mild to severe impairment Too few intact females in population to draw any conclusions Behaviors Interdog aggression Human directed aggression Resource guarding Roaming Urine marking Fear Reactivity Maternal aggression Mounting Territorial aggression Noise phobia Separation anxiety Age related cognitive changes 12

28 Take home messages Contradictory data for many of the specific behaviors Hormone status is only one of the factors that influences behavior Overwhelming lack of recent, prospective, longitudinal, intervention based, controlled/blinded studies on which to base conclusions Questions? 13

29 FELINE INAPPROPRIATE ELIMINATION UNRAVELING THE MYSTERY Christopher Pachel, DVM Diplomate ACVB Animal Behavior Clinic Portland, Oregon Feline elimination Urogenital stimulation for first few weeks Voluntary elimination by 3 weeks old Natural tendency to scratch loose sand/dirt Investigate litter box by ~30 days Feline elimination Successful use of elimination location within several days Toilet area learned by watching queen and by olfactory cues Provide convenient access to desired location and substrate 1

30 Elimination problems Common in household cats 57% of feline referral cases 23% of cats relinquished had daily/weekly incidence of house-soiling 9% of cats exhibit housesoiling within 3 months of adoption Elimination problems Time consuming and frustrating for owners and for veterinarians! Important to diagnose and treat accurately for successful outcome! Where do you start? 2

31 Rule out medical problems Increased urine volume Renal insufficiency, diabetes Urgency Cystitis, infection, urolithiasis Pain/discomfort Arthritis Constipation Lower urinary tract disease Obesity Veterinary evaluation Physical examination Minimum database Urinalysis ± C&S CBC/Chemistry/T4 Stool evaluation Imaging (not optional) X-rays Contrast imaging or ultrasound Veterinary evaluation No difference in urinalysis results between urine marking cats and cats without elimination problems 38% of spraying cats had abnormalities of urinary tract on comprehensive workup 55% of cats with inappropriate elimination have medical problems Treat any underlying conditions! 3

32 Housesoiling? Medical Toileting Marking Spite Housesoiling? Medical Toileting Marking Spite Toileting Normal elimination in unacceptable location Categorized by: Preferences Aversions May be caused or influenced by Medical problems Anxiety/stress 4

33 Toileting Less than acceptable litter box Poor hygiene Not preferred litter Box style/size Limited access to box Tension between cats Ambush! Learned preferences Other stressors affecting elimination sequence or accessibility of box/location Marking Deposition of urine on vertical surface (usually) Characteristic posture and sequence Form of communication Social and spatial organization May include stool middening Marking More likely if territory is threatened or in response to stressor Normal behavior but unacceptable in most homes 10% of castrated males, 5% of spayed females 5

34 Toileting vs. Marking Volume of deposited urine may be similar for toileting or marking Social stress or conflict may be present in households with either problem Fluorescein unreliable How do you tell??? Four questions Q: Location of periuria? (Horizontal or Vertical) Q: Concurrent perichezia? (Yes or No) Q: Substrate pattern to periuria? (Yes or No) Q: Litterbox set-up? (Good or Poor) Credit to Dr. Jacqueline Neilson Location of Periuria? Vertical = Marking Horizontal = Marking OR Toileting Concurrent Perichezia? Yes = Toileting No = Marking OR Toileting Substrate pattern to periuria? Yes = Toileting No = Marking Litterbox set-up? Good = Marking Poor = Toileting 6

35 Location of Periuria? Vertical = Marking Horizontal = Marking OR Toileting Concurrent Perichezia? Yes = Toileting No = Marking OR Toileting Substrate pattern to periuria? Yes = Toileting No = Marking Litterbox set-up? Good = Marking Poor = Toileting Location of Periuria? Vertical = Marking Horizontal = Marking OR Toileting Concurrent Perichezia? Yes = Toileting No = Marking OR Toileting Substrate pattern to periuria? Yes = Toileting No = Marking Litterbox set-up? Good = Marking Poor = Toileting What s the pattern? Working through four questions usually points in consistent direction Does the diagnosis matter? YES! Treatment is different for each problem 7

36 Treatment of Toileting problems A = A B C D Accessible Big Clay, Clumping Clean, Carbon Different option (if medical or conditioned emotional response) A = Accessible Location, location, location! Avoid Noisy appliances Dead ends Other pets, children N + 1 = number of litter boxes in multiple locations Look through history for potential aversions B = Big Minimal scientific evidence Data suggests trend for large box preference Allow for comfortable entry and movement Many prefer uncovered box 8

37 C = Clay, clumping, clean, carbon Preference for fine sand-like substrate Hygiene may matter for individual cats Established preference for litters with activated carbon (odor control) Scented or unscented? Equivocal data D = Different Powerful associations with medical illness or pain/discomfort May need to offer different option to create new experience Less common than other treatments Treatment of Toileting problems A, B, C, D Goal = Provide attractive box, location or substrate Reduce attractiveness of alternative elimination spots? Pros and cons Carpet runner, alum. foil Confinement away from soiled areas 9

38 Treatment of Toileting problems Preference test may be required Cafeteria vs. systematic trial Substrate, box type, location, litter depth Monitor usage of each box for 3-5 days to establish preferences Treatment of Toileting problems Scoop daily, change weekly, clean monthly Enzymatic cleaning of soiled areas Drug therapy IF anxiety is associated with elimination Age appropriate box (kitten to geriatric) Treatment of Marking problems A = D E F G Drugs Environmental enrichment Feliway Gonadectomy Get rid of triggers 10

39 D = Drugs No medications FDA approved for cats Research on fluoxetine and clomipramine Generally effective and well tolerated Days to several weeks to take effect E = Environmental Enrichment Plentiful resources Food and water Resting locations Litter box access Physical and social Litter box management Scratching posts F = Feliway (CEVA) Analogue of F3 facial pheromone Encourages bunting and other forms of marking Emotional stabilization Improvement in social relationships Available as diffuser (~600 ft 2 ), non-aerosol spray (apply 1-3 times daily or to effect), or wipes 11

40 F = Feliway (CEVA) Initial studies showed 74-97% response for urine marking Ongoing months for 77% Study of 36 cats Eliminated marking in 37% Decreased (by >50%) in 40% No significant change in 23% Decreased response if ongoing intercat aggression within household G = Gonadectomy, Get rid of triggers Urine marking decreases 90% after male castration Block access to outdoor stimuli blinds, window coverings Outdoor deterrents odors, Scarecrow, physical barriers Separation of indoor cats Behavior modification for identifiable triggers Treatment of Toileting problems A = A B C D Accessible Big Clay, Clumping Clean, Carbon Different option (if medical or conditioned emotional response) 12

41 Treatment of Marking problems A = D E F G Drugs Environmental enrichment Feliway TM Gonadectomy Get rid of triggers Ariel 7yr spayed female domestic short hair, 7# Skittish, adopted as kitten Living in current home for 3 years 6 month history of periuria Stool found initially outside utility room Urinated multiple times on bathroom rug Closed bathroom door, urinated on carpet in hall Ariel Two boxes available in utility room Medium size, uncovered Unscented liner (front declawed) Scoopable litter Scooped daily, changed weekly No other box or mgmt changes that owners could recall during initial questioning 13

42 Ariel Noise sensitive cat Body language in utility room consistent with fear/anxiety Tentative, hypervigilant Reluctant to enter Access to utility room through flap By the way furnace problems around time of onset Location of Periuria? Vertical = Marking Horizontal = Marking OR Toileting Concurrent Perichezia? Yes = Toileting No = Marking OR Toileting Substrate pattern to periuria? Yes = Toileting No = Marking Litterbox set-up? Good = Marking Poor = Toileting Ariel Urinalysis within normal limits rdvm started on fluoxetine 2.5mg once daily Socially avoidant after pilling Owners discontinued medication after 7-10 days Plugged in Feliway diffusers More relaxed, more social with visitors No change in elimination pattern Added box on upper level Immediate consistent use Unacceptable long term solution for owners 14

43 Ariel - Toileting A: Added box in workout room B: Not relevant C: Continue box maintenance D: Not relevant End result? Box still in basement (acceptable to owner) Box is away from utility room (acceptable to Ariel) Option to move it slowly back towards utility room Princess and Squeakers Princess - 15yr spayed female domestic short hair Lived with cat Junior for 3 years no problems Owner recently adopted 3 yr old cat Squeakers Onset of urination on main level of house In planter near front door On carpeted horizontal surfaces in same area Daily soiling Two level town home Princess and Squeakers Two uncovered medium to large boxes Both on upper level Unscented liner Unscented clumping litter Scooped 2x/week Changed q3-4 weeks 15

44 Princess and Squeakers Added 3 rd box No change in frequency of soiling No other interventions prior to referral Princess and Squeakers Frequent aggression from Squeakers towards Princess Princess stopped going up to second level of home Hypervigilant, remained on back of couch Majority of conflicts near stairway to upper level Location of Periuria? Vertical = marking Horizontal = Marking OR Toileting Concurrent Perichezia? Yes = Toileting No = Marking OR Toileting Substrate pattern to periuria? Yes = Toileting No = Marking Litterbox set-up? Good = Marking Poor = Toileting 16

45 A: Accessible Princess - Toileting Added box in living room Modify home layout (walkway on stairs, additional perches) Address conflict between cats (food and water stations, belled collar, Feliway) B: Not necessary C: Increase cleaning frequency D: Not necessary Cletus 9yr neutered male domestic short hair, 12.5# Littermate Carmichael also lives in home 3-4 month duration urination inside home caught in act with upright stance and quivering tail All on vertical surfaces 2 uncovered boxes Located in laundry room and exercise room Medium to large No liner Cat attract, Tidy cat scoopable Scooped daily Changed monthly Cletus 17

46 Cletus Urinalysis NSF Recommended second box, increased cleaning Started amitriptyline no change Repeat urinalysis 2 months later NSF Increased amitriptyline dose Treated with antibiotic for 10 days Owner scheduled appointment for euthanasia but opted for referral CBC, chemistry, T4, 2 view abd. radiographs - WNL Location of Periuria? Vertical = Marking Horizontal = Marking OR Toileting Concurrent Perichezia? Yes = Toileting No = Marking OR Toileting Substrate pattern to periuria? Yes = Toileting No = Marking Litterbox set-up? Good = Marking Poor = Toileting Cletus Urination started after bringing in outdoor clay pots Outdoor cat has marked on house and through screen door Cletus screams, hisses and may attack Carmichael when the other cat is seen in the yard Posture consistent with urine marking All soiled rooms face back yard 18

47 Cletus D: Candidate for medication E: Increased resources F: Feliway diffusers G: Already neutered, live trap for stray, Scarecrow and Liquid Fence, blocked view at back door Belled collar for Cletus Treatment of Toileting problems A = A B C D Accessible Big Clay, Clumping Clean, Carbon Different option (if medical or conditioned emotional response) Treatment of Marking problems A = D E F G Drugs Environmental enrichment Feliway TM Gonadectomy Get rid of triggers 19

48 Thank you! 20