Feline Health

It's Flea Season!

It's Flea Season!

Let’s talk about fleas…you know, those pesky little black bugs that like to live on your pets! Here is South Carolina, we generally don’t have cold enough winters to really kill off fleas - so while fleas are definitely worse in the spring, summer, and fall, they are still around in the winter as well, just in smaller numbers. This is why it is important to use flea medication year round in our climate. Your animals can get fleas any time they go outside (even if it’s just a quick trip to relieve themselves), from other animals, or even sometimes through the screens on porches or from you if you happen to carry some in on your clothes. Even indoor cats can end up with fleas!

Non-Anesthetic Dentistry (NAD) vs Anesthetic Dentistry

Non-Anesthetic Dentistry (NAD) vs Anesthetic Dentistry

The importance of maintaining a healthy mouth is, appropriately so, becoming more and more a priority. We understand one of the key parts of accomplishing this task is regular dental cleanings and dental radiographs. These require general anesthesia…and anesthesia can be scary! The inner dialogue has changed from thinking dentals aren’t necessary or worth the money, to knowing the benefit but wondering if it’s worth the risk.

Feline Holiday Shopping Guide

Feline Holiday Shopping Guide

Still November, still thinking about holiday gifting? Let’s consider what your cat may enjoy receiving this year. Since they are not small dogs, there’s a shift in toy selection. Domestic cat behavior is closer to the behaviors we see in wild cats - hunting, lounging, grooming, scratching. We want to keep them happy and engaged. We want to minimize or redirect their more destructive behaviors. Cats, like dogs, benefit from toys that keep them mentally and physically active. Indoor cats especially benefit from environmental enrichment - it lessens their stress levels, which can lower your risk of having a cat with behavioral issues. Win-win situation!

Hyperthyroidism in Cats

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Quick Facts: Hyperthyroidism...

  • Is the most common glandular disorder in cats.
  • Can be found in cats of all breeds and sex.
  • Has an average onset at age 12-13 years (although in rare cases can occur in cats younger than 10).

Clinical Signs Include:

  • Weight loss despite an excellent appetite
  • Excess thirst
  • Restless and needy behavior
  • Intermittent vomiting or diarrhea
  • Urinating outside the litter box

Diagnosing the Disease

During your cat's physical exam, the thyroid glands will be palpated. In normal cats, the lobes of the thyroid gland cannot be felt with your fingers. In a hyperthyroid cat, at least one lobe is usually prominent and may be detected by your veterinarian. A full lab work panel, including a Free T4 by Equilibrium Dialysis, will determine your cat's thyroid function. Findings from the exam and lab work along with noted medical history and clinical signs will help determine a definitive diagnosis. 

Symptoms if Left Untreated

Hyperthyroidism is caused by a benign growth in the thyroid gland that is over-producing T4. Hyperthyroid cats often have a reduced quality of life through weight loss, muscle deterioration, chronic vomiting or diarrhea, heart disease and high blood pressure which can result in heart failure, sudden blindness or sudden death. Good news...all of the above can be prevented with treatment for thyroid disease!

Treatment Options

Radioactive Iodine (I 131)

The gold standard for treatment of hyperthyroidism in cats is a radioactive scan to confirm the disease location and size of the glands followed by a therapeutic dose of Iodine 131. This treatment involves an injection followed by 3-7 days of hospitalization. No anesthesia is required and the treatment is curative. Disadvantages to this option are that the owner is separated from their pet during the hospitalization period and children and pregnant women can have no contact with their cat for 1-2 weeks after therapy. Also during this time, a special flushable litter must be used. This treatment method is not appropriate for cats with kidney or heart failure. I 131 therapy is available locally by referral to the Feline Hyperthyroid Treatment Center of Charleston and is quoted at $975.

Medicating with Methimazole

The most common treatment for hyperthyroidism is a medication called methimazole which blocks the production of T3 and T4. After the treatment has been given for 2-4 weeks, the thyroid levels must be checked and regularly monitored to insure the correct dose is being administered. This option is often popular because the medication is relatively inexpensive and no hospitalization is required. Disadvantages to this method of treatment include the inconvenience and difficulty of medicating every 12 hours. While side effects are uncommon, those that do occur will typically become present within the first three months of treatment. Medicating with methimazole can sometimes unmask or worsen kidney disease. 

Prescription Diet y/d

For the occasional cat who is not a good candidate for routine medication and Radioactive Iodine is financially out of reach, there is a commercial diet available through your veterinarian. Hill's Prescription Diet y/d is reduced in iodine with the idea that excessive thyroid hormone levels can not be produced if there is not enough iodine in the diet to support their production. It is claimed that this diet can normalize a cat's thyroid in 8-12 weeks but must be fed exclusively, meaning no treats, access to other pets' food, or time allowed outside. Once a cat is transitioned to this diet, it is recommended that thyroid levels, kidney parameters, and urine concentration is checked at 4-8 weeks then monitored every 6 months thereafter. 

Who Peed on the Rug?? Or...Feline Idiopathic Cystitis (FIC)

A complaint cat owners sometimes have is that their cat is urinating outside of the litter box. There are various medical and behavioral problems that can cause this, but we will focus on one condition in particular called feline idiopathic cystitis, or FIC for short. FIC is a sterile inflammatory disease of the bladder in cats, particularly indoor cats.

While all the causes of FIC are not entirely understood, stress is an important component. Research has shown that in susceptible cats, stress can result in inflammation of the inner lining of the bladder. Once this happens, the cells in the bladder can become further irritated by the urine and cause even more inflammation. Some cats are more prone to feeling stressed when their owners' schedules change, new people or animals are around the house, stray cats are in the yard, if there are any changes to the litter box, etc. 

Just because your cat is lounging around the house does not mean he is not stressed! Cats are good at hiding their feelings so we do not always know what they are thinking or feeling.

Signs you may see at home can include urinating out of the litter box, urinating small, frequent amounts, straining to urinate, and bloody urine. Male cats with this condition can develop a urinary obstruction, meaning that they have an obstruction in their urethra (the tube that goes from the bladder out) preventing them from being able to urinate: this is a medical emergency. Signs of FIC are often mistaken for a urinary tract infection (UTI). UTIs in young, healthy cats are actually quite uncommon (less than 1-2% incidence), so it is important to check for infection before treating with antibiotics! Bouts of FIC usually run their course in 3-7 days, so just because a cat has been treated with antibiotics and improved does not mean there was an infection present. This inflammatory disease is often a recurrent problem, which can be frustrating for owners and uncomfortable for the cats.

If you notice any of these signs in your cat, he or she should be evaluated by a veterinarian and have tests done (usually a urinalysis and urine culture) to make sure there is not an infection present. There are some medications that can be used to help decrease pain and spasming of the urethra, but ultimately the inflammation has to run its course. Crystals can sometimes be seen on the urinalysis, but unless there are bladder stones present (which would be seen on x-rays), these are considered secondary to the disease, not a primary cause, and therefore do not necessitate treatment.

There are, however, some changes that can be implemented at home to help decrease the risk of recurrence or decrease severity of signs:

  1. Water Intake: It is believed that increasing water intake can help to promote more frequent urination and prevent accumulation of debris which can trigger inflammation or cause an obstruction. This can be done by feeding wet food rather than dry, making sure there are multiple bowls of fresh water, adding tuna juice to the water to entice water consumption (although be sure to change this frequently to make sure it does not go rancid), or by getting a running water bowl.
  2. Litter Boxes: Maintaining an adequate number of clean litter boxes also serves to promote more frequent urination. There should be one litter box in excess of number of cats (for example, if you have two cats there should be three litter boxes). It is also important that the boxes are cleaned regularly. If clumping litter is used, it should be scooped every day to every other day (ideally twice daily!) and cleaned entirely every 1-2 weeks. Many cats do not like liners or covered boxes as well, so if this is present it is recommended to remove the liner and uncover the box.
  3. Environment: Environmental enrichment, especially for indoor cats, can help decrease stress. This includes making sure there are an adequate number of toys and positive interaction with people by setting aside play time every day. It is also important to have areas that the cat can call his or her own to escape to, as well as providing elevated surfaces (for example, cat towers) they can climb and sleep on. Sometimes leaving music or television on while you are gone can be helpful. Also, it can be stressful for cats inside to see another cat outside in the yard in their territory. If this is the case, blocking the window so that they stray cat cannot be seen may help decrease stress.

Curiosity Saved the Cat: Ask Missy Anything Answers!

Hi Missy,

Our cat is an only pet. She is old, frail and never leaves her home. We hate for her to have to endure the annual visit and inoculations. Are all these shots absolutely essential for her well-being?

Love your glasses,
Pussy Willow's Mom

Dear Pussy Willow's Mom,

Good question, thank you!

While vaccinations are an important part of feline wellness care, the MOST important part of each visit is the doctor's physical exam. During a routine exam, veterinarians palpate (or feel) organs, check for arthritis which is common in senior cats, and listen to the heart and lungs in addition to noting the outward appearance of skin/hair coat, eyes, ears, mouth, etc. We also recommend annual blood, urine, and fecal testing which can help us catch and treat problems that are otherwise undetectable at early onset.

Cats are great at hiding problems until they become critical and the early stages of illness are usually very subtle. In the wild, this natural behavior extends life as an apparently strong, healthy cat is less vulnerable to predators. This instinct often does not dissipate within the protective walls of your home, but your watchful eye could help identify signs of trouble early. These signs could include increased thirst and/or urination, changes in appetite, unusual wandering throughout the house, howling, hiding, or not using the litter box appropriately.

As for the vaccines themselves, we recommend indoor-only cats remain current on their core immunizations: Rabies and FVRCP (aka HCP). The Rabies vaccine is required by state law to protect pets and humans alike. FVRCP is identified by feline veterinary specialists across the nation as a core vaccine group for all cats regardless of lifestyle. While exposure to these viruses is limited for Pussy Willow, their benefits likely far outweigh the risk of vaccination. Our doctors are happy to go through the pros and cons list on an individual basis during your pet's visit to help you make an informed decision as to what's best for you and your cat.

In short, while we do want to make sure our feline patients are current on their recommended vaccinations, we also want to stress the importance of regular exams with a veterinarian. We understand trips to our hospital can be taxing on pets and owners alike - especially for our elderly kitties - and sympathize with you whole-heartedly. Our entire team has been working hard to create a more relaxed environment for cats. A cat-only exam room with diffused pheromones and low-stress handling techniques are two ways in which we are achieving this goal. Ulimately, we truly believe that regular visits - ideally every 6 months, but at least once per year - are essential for a cat's well-being.

Linked below are some more articles that might help answer your questions! Please let me know if you have any follow-up questions I can answer for you.

"Carriers and Car Rides" article link

"Wellness Exams" article link

Thanks for being a great cat mom!

Missy

P.S. I love my glasses too, thank you!

Dear Missy,

One of my kitties, Charlie, likes to wake me up every morning by licking my face and hands and also poking me and meowing at me. I realize I've created a monster by serving her breakfast as soon as I get up so I know she wants to be fed (because she guides me right to her bowl) but why does she lick so much?

Thanks,

Charlie's Mom

Dear Charlie's Mom,

Please take a moment and read this article from the ASPCA, I think you will find the answer you are looking for! In this article, you will find helpful tips on correcting this licking behavior as well.  

You will find often that I quote Jackson Galaxy, the cat behaviorist on Animal Planet. He is an amazing resource. He mentions in one of his many blogs that regulating a cat's digestion will help regulate their energy. I see you feed Charlie twice a day, canned Fancy Feast and 1/8 cup Royal Canin dry. You are already off to a great start! Why don't you try splitting up her portions into three meal times that fit your schedule? Plan the last meal about 1.5 hours before you go to bed. Before feeding, get a "Da Bird" wand (Amazon or PetCo) or something similar and interactively play with her for 10-15 minutes. Wear her out then feed her. Afterwards, she'll start to groom and head to bed with you with a full tummy and hopefully won't be as lovably obnoxious. Ideally, this should be done before breakfast too for best results.

Cats still have their ancestor's instincts even though we have domesticated them:

HUNT-->CATCH-->KILL-->EAT!

I would expect to see an improvement in this behavior within 10-14 days if you can commit. Consistency is key!

Thanks for your question! Keep me posted!

Missy

Dear Missy,

My cat was an abandoned cat in the Park Circle area and she was desperately thin and shy. Her owner had kicked her out since she is untrusting and will not be handled. After over a year living at my house she will let herself be gently petted sometimes but only with one hand, not two that could grab her unexpectedly. She has been living with me for 5 years now, but she is still not affectionate although I can corner her and get her in a crate for her annual visits to DIAH. The price I pay is that it takes about a month for her to let me touch again. So, as you can imagine, I don't crowd her. I have to let her come to me.

She will only sulk in the closet corner or under the guest bathroom sink cabinets (she is good at getting doors open) if I try to keep her indoors only. So, reluctantly, she has access to the doggy door which she uses easily. But, she mostly sits out on the back patio watching birds, chasing lizards.

She has been at DIAH several times with the crystals in the urine business. I have tried to convert her to wet food, but she just starts to not come home for days if she doesn't get her kibble which is the only thing she thinks is cat food, not cheese, yogurt, chicken pieces, etc. The big problem is that she doesn't drink enough on her own. Is there something I could put in her food that looks like kibble that would make her drink more water?

Nala's Mom

Dear Nala's Mom,

Thanks for your questions. I have some thoughts but there are situations where I feel like a home visit may be warranted. This may be one. I'll give you suggestions and we'll see.

Obviously, as you mentioned, she has trust issues. We can work with that. It will take time as there aren't usually any quick fixes.

I see you have two beagles. Just from reading some history she sounds like a big time stress kitty. Make sure she has a place in your living room where the family congregates where she can be with you all. Some place high, not just the back of a couch or top of the refrigerator. She needs to be able to have a quick escape from these high places so should she need to use a litter box, she can do so without feeling threatened.

Get a "Da Bird" wand off Amazon or at PetCo. Play with her for 10-15 minutes before meals...this will instinctively get her hunting behavior out. You may not want pups to be present during play. She needs a lot of environmental enrichment. It's awesome she gets to watch the birds and the lizards...let's get her to find something. Get a food puzzle, like the Pipolino, for cats and make sure you feed her just twice a day. She can roll it around and her food will drop out little by little.

Make sure she has 2 litter boxes in different locations. These boxes ideally need to be much larger than she is...she needs room to fully turn around inside the box. Wal-Mart and many other stores have done cats a disservice by selling the tiniest litter boxes known to man.

I am available for house calls. I would try the things described above (Da Bird wand, food puzzle, and verticle spaces) first to see if it helps with her trust.

Take care,

Missy

>^..^<

Combating Cabin Fever

We all know the phrase "Cabin Fever," and how boredom can make us do things we may not normally do if we were otherwise pre-occupied or content. This is something our pets may feel all too well. Statistics show that boredom, or lack of enrichment, can lead to many behavior problems if not caught soon enough. Lack of mental stimulation or opportunities for our pets to satisfy their natural instincts and behaviors can cause them to act out in ways that we only understand as "bad behavior." In a perfect world, humans and domesticated animals would live together in perfect harmony while entertaining one another's instincts.

Because this world does not exist, we must find ways to satisfy our pets' needs that don't involve our dogs digging to China in our backyard or our cats knocking every single item off of every shelf in an attempt to see which one will play back with them. The idea of enrichment is to provide mental and physical stimulation for our pets to help them live more rewarding and full lives. In the long run, this will help avoid naughty behaviors that may eventually break down that bond you and your four legged child may have.

We all know that ideally dogs would love to walk miles and miles each day and sniff every single blade of grass along the way. Cats would love to chase butterflies in the sunshine for hours on end. Unfortunately, because of our busy lives, this is not always an option. This does not mean there is no hope for your dog or cat. There are many ways to help them achieve the mental stimulation they need. Many of these things can be accomplished with household items you may already have.

Tips to Combat Your Pet's Cabin Fever

Toys: A rule of thumb is that 3 toys should be provided per pet, per day. These items can be switched out and reintroduced every 5 days to help maintain novelty. Keep in mind that you should be cautious of your pet's normal chewing behavior to avoid ingesting any part of the toy. Examples for dogs are rope toys, tennis balls, squeaker toys, and Kongs. Some options for cats are toy mice, jingle balls, and feather toys.

Environmental: Animals naturally enjoy viewing their environment from different angles. This may be easier to accomplish for cats because they are more inclined to climb on counters, shelves, and basically anything in reach. If an option, it would be valuable to allow your cat to have an area, or several, that they are encouraged to climb up on. Empty shelves mounted on a wall that create a ladder effect work great but a standard cat tree is beneficial as well. An idea for dogs is to allow visual access through a window or door. Not all dogs are a good candidate for this especially if they are typically reactive to seeing other people or dogs outside. A good option for those dogs is to leave on the television or radio.

Exercise: This category is one of the most important ones. This is beneficial for overall health but can also have a major effect on naughty behavior such as separation anxiety and and other negative results of pent up energy. Routine walks for your dog are certainly beneficial but there are particular reward neurotransmitters (nerve messenger cells) that are not released unless your pet undergoes high intensity endurance running. Essentially, there are certain functions of your pet's brain that are not stimulated unless this type of exercise exists for them. If you are not typically a runner, dog parks, open fields that allow pets, and even your back yard are a great option to help them reach these needs. It wouldn't be recommended to harness your cat and take him on a 3 mile run, but they can get their daily workout with a little help from you. A cat will chase a feather string toy or laser light for hours. This is encouraged to help them burn energy but it also has a great effect on their self-confidence.

Brain Puzzles: With a little creativity, you would be surprised how many ways you can provide your pet with enrichment. Dogs and cats love new scents. Think of all the things there are to smell while they are on a walk or outside. By using a spray bottle and infusing scents like cinnamon, rosemary, lavender, or chamomile onto your pets favorite bedding or toys, you can provide them with a change to seek and explore. Toxicity potential should be evaluated before using any product. Alternating scents is the best way to keep this a fun adventure for your pet. Empty cardboard boxes with windows cut in them can provide a fun hideout for your cat to explore. Laundry baskets with or without fabric in them placed in various positions provide a new obstacle for your cat to conquer. Switching out different types of fabrics can create an opportunity for your pet to rub and roll for more tactile stimulation.

Fun with Food: Food puzzles are a wonderful opportunity for your pets to engage in their natural instinct to hunt for food. These puzzles can be purchased at most pet stores or made by using cardboard boxes and plastic containers. If you live in a single pet household, spreading his or her meal out in separate rooms gives your pet a great excuse to sniff and search to find the food. If your pet is food motivated, using food puzzles during stressful events like thunderstorms or separation can keep him or her occupied and help with counter conditioning. Using empty egg carton containers to feed your cat or small dog is an easy option. As a treat, you can fill a Kong with peanut butter or freeze a bowl of water mixed with treats or chicken broth to entertain them for a while.

The possibility for enrichment ideas are endless! As always, you must take your pet's individual needs and current health into consideration as not all of these options are suitable for every pet and household. For assistance or questions about anything in this article, don't hesitate to contact us!

Vaccine-Associated Sarcomas in Cats

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What is a vaccine-associated sarcoma (VAS)?

A sarcoma is a type of cancer that affects mesenchymal cells, which can be found in tissues such as fat and muscle.  VAS is a sarcoma that is potentially induced by a vaccination. The real cause is a genetic predisposition which can cause the effected cat’s inflammatory cells to get out of control and release a substance that causes DNA damage.  It is normal for a vaccine to cause a little localized inflammation. It is only in a small minority of cats (about 1 in 10,000) that this inflammation can get out of control ultimately leading to a sarcoma. This situation is very rare, but concerning if it does occur.

My cat has a bump at his vaccination site, should I be worried?

Often, cats will have a slight inflammatory reaction and a small granuloma (bump) will form. A granuloma is not a concern and should go away in a few months. However, if the bump does not go away or continues grow, you should talk to your veterinarian about testing the lump to determine if it is cancerous. 

What if my cat’s lump ends up being a sarcoma? Will my cat be okay?

At this point, you and your veterinarian will discuss treatment options. This may includes surgical removal of the lump, radiation therapy, and chemotherapy. The extent of treatment necessary is very dependent upon your individual animal and how far your animal’s cancer has progressed. Though rare, this is a cancer, and a very serious disease and prognosis will depend heavily on the extent of disease present and response to treatment.

Even though it’s rare, why even take the risk? Should I continue to vaccinate?

Yes! This may sound like a simple answer but neglecting core vaccinations will likely do your pet more harm than good. Vaccinations are given for a reason and they are often to prevent very nasty and often fatal diseases. Some of these diseases, such as rabies, are also zoonotic (can infect humans). If you avoid vaccinating your cat you may end up not only putting your cat at greater risk for infection, but putting yourself and others in harms way as well.

Can I at least limit the amount of vaccinations I give?

Yes – you and your veterinarian may discuss if there are certain vaccinations that may not be necessary. These vaccines will most likely be vaccines for certain diseases that are not prevalent in your area or your cat will unlikely be exposed to. To reduce the risk of sarcoma further, our hospital uses the PureVax line of vaccines specifically formulated for cats without an adjuvant so post-injection inflammation is even less likely.

Have questions about your cat’s vaccines? Please ask! We are happy to address any specific concerns you may have about your furry family member. That’s what we are here for!

Keeping Our Pets Safe

We had a recent request for a blog about keeping pets safe on Daniel Island. This question is important because of the natural predator population on the island. The following hunting species are part of the natural beauty of our community:
— Alligator, Bobcat, Coyote, Eagle, Hawk

    We also have abundant raccoon, opossum and feral cats who would fight a cat for territory.  In 2009, a case of rabies in a raccoon from Daniel Island was confirmed; proof that the virus is present here. View the SC DHEC annual rabies report here.

    Other diseases carried by wildlife which can affect our pets are heartworms, intestinal parasites and Leptospirosis. The best way to avoid exposure to these diseases is to keep cats indoors and keep dogs on a leash and out of wildlife habitat areas. For more on the "Indoor Pet Initiative", check out The Ohio State University College of Veterinary Medicine website.

    This question is also timely with the recent Post and Courier news story about a pet cat on Daniel Island being trapped and moved off the island because a neighbor found the cat to be a nuisance.  Our neighbors may not be pet loving people, and it is in our pets’ best interest for us to prevent them coming into contact with people who do not appreciate their unselfish, loving companionship.

    On Daniel Island, we are in the city limits of Charleston proper.  Chapter 5 of the city’s municipal code states:

    “Every person owning or having possession, charge, care, custody, or control of any animal shall keep such animal exclusively upon his own premises; provided, however, that, any such animal may be off such premises if the animal is restrained by a chain or leash or other means of adequate physical control, provided, however, that, when any animal destroys or damages any property, attacks, threatens to attack, or interferes with any person in any manner, becomes a nuisance, or strays onto the private property of another, there shall be a presumption of law that the animal was not restrained by a chain or leash or other means of adequate physical control.”

    If a neighbor’s cat is a nuisance, and you wish to keep them off your property, I recommend a motion-activated sprinkler by Contech called the ScareCrow.  The sudden noise, movement and spray of water are humane ways of teaching animals of all types to avoid your landscaped areas.

     

    Litter Box 101 (pt 1)

    Here are some tips for setting up that all-important litter box and making it the place your cat wants to go:

    1. Provide a type of litter that your cat loves, preferably unscented. There are many litter choices, but most cats prefer clumping clay litter. To figure out your cat’s litter preference, offer different options in various litter boxes and retain the one that gets used the most.
    2. Scoop at least once a day — twice is better. Cats don’t appreciate dirty toilets. At least once a month (or weekly if it’s not a clumping-type litter), dump all the litter and wash the entire box with soap and water.
    3. Even if you have just one cat, you will need two boxes. Ideally, there should be one more box per household than the number of cats.
    4. It may be best to skip a litter box liner, as some cats don’t like the feel of the plastic and sharp cat claws can puncture the liner. Also, liners have a tendency to hinder box scooping with clumping litters.
    5. While some cats prefer covered litter boxes, most do not.
    6. Location matters. For example, litter boxes up or down a set of stairs might be a problem for older cats. Litter boxes near a loud appliance might be scary. Ideally, litter boxes should offer cats a view of what’s going on as they do their business, yet still provide some seclusion. Litter boxes should not be placed where children play, as there can be too much commotion for some cats. And when possible, keeping dogs away from the box is a good idea.
    7. Supersize the boxes. Big and overweight cats just don’t have enough elbow room in many of today’s boxes. Try a plastic storage container instead (the kind used to store sweaters under the bed). If the cat  is standing in the box but the urine ends up outside, try a plastic storage box with high sides. Just remember to cut out an opening (that isn’t sharp) so the cat can easily get in and out.
    8. Anxiety can play a role in cats missing the box. More than anything else, cats dislike change. The death of a pet, the addition of a new pet, or the owners going away on vacation can prompt a cat to miss the box. Give the offender a chance to blow off that stress by offering more interactive play and providing environmental enrichment. Another cause for anxiety may be the relationships in multi-pet homes. Cats can be surprisingly subtle about their disagreements. You may not see any overt catfights, but one cat may still be subtly preventing another from using the box in peace.