ER VET

In this episode of ER VET, Dr. Justine Lee, DACVECC, DABT talks with Dr. Mark Cousins, DABVP (Feline Medicine), CVPP, IVAS on how to tell if your cat is in pain. If your cat is chewing weird and making a mess, or defecating outside of the litter box, tune in to learn more! We don’t want to miss the subtle signs of pain that cats show!

Listen to Episode #187 Now:

BIO:

2012: Awarded Certified Veterinary Pain Practitioner (CVPP), awarded by the International Veterinary Academy of Pain Management (IVAPM)2012: Awarded Certified Veterinary Acupuncturist (CVA), granted by the International Veterinary Acupuncture Society2008: recertified, Diplomate, American Board of Veterinary Practitioners, Feline Practice2000: Diplomate, American Board of Veterinary Practitioners, Feline Practice1993-1995: Veterinary Management Institute at the Krannert School of Business, Purdue University -- post-graduate training course encompassing the aspects of finance, marketing, personnel management, and strategic business planning for a veterinary practice1976-1980: Louisiana State University School of Veterinary Medicine, Doctor of Veterinary Medicine degree (DVM)1974-1976: Louisiana State University undergraduate work.1970-1974: Jesuit High School, New Orleans, LaAWARDS/HONORS:2012: Feline Friendly Practice, Gold Level; awarded by the American Association of Feline Practitioners to The Cat Practice, Inc2005: Hospital of Merit, Veterinary Economics, Design Competition, The Cat Practice, New Orleans1999: New Orleans/River Region Chamber of Commerce Rising Tide award; Category: Business Innovation1996: Certificate of Merit-Jefferson Parish Council (for participation in the "Visiting Vets" program)1995: Certificate of Appreciation- Kenner Police (for pro-bono care of their drug dog)1993: Outstanding Service Award-Southeast Louisiana Veterinary Association.1982: American Animal Hospital Association Excel Award.1976: Alpo Scholarship; Alpha Zeta Scholarship1974: Summa Cum Laude-Jesuit High School

Transcript:

[00:00:00]:
Pet Life Radio.

[00:00:02]:
This is Pet Life Radio. Let's talk pets.

Justine Lee [00:00:26]:
Welcome to er vet on Pet Life Radio. I'm your host, Dr. Justine Lee, and I'm a board certified emergency critical care, veterinary specialist and toxicologist. Thanks for joining us today. You cat owners are in for treat. We're going to be speaking with Dr. Mark Cousins who is a diplomat of the American Board of Veterinary Practitioners in feline Medicine and feline guru, especially in the Louisiana area. So we'll be talking to Dr. Cousins in just a few minutes, right after these messages. Take a bite out of your competition. Advertise your business with an ad in Pet Life Radio podcasts and radio shows. There is no other pet related media that is as large and reaches more pet parents and pet lovers than Pet Life Radio. With over 7 million monthly listeners, pet Life Radio podcasts are available on all major podcast platforms and our live radio stream goes out to over 250,000,000 subscribers on iHeartRadio, Odyssey, TuneIn and other streaming apps. For more information on how you can advertise on the number one pet podcast and radio network, visit petliferadio.com advertise. Today.

Mark Cousins [00:01:41]:
Let's talk pets on petliferadio combat.

Justine Lee [00:02:01]:
On Pet Life Radio today, I'm really excited to talk about all things feline. I'm going to be speaking with Dr. Mark Cousins. Dr. Cousins, thank you so much for joining us today.

Mark Cousins [00:02:10]:
Thank you, Doc. I appreciate your invitation to be here.

Justine Lee [00:02:13]:
Of course.

Mark Cousins [00:02:14]:
Love talking about cats.

Justine Lee [00:02:15]:
I love it. I love talking about cats too. Now, just so our audience knows who you are, do you mind just talking about who you are, where you train, what you do, and what all the letters behind your name mean?

Mark Cousins [00:02:28]:
Well, I've been out of school since 1980. I graduated from Louisiana State University. That's where I got my DBM degree. My Doctor of Veterinary Medicine degree. I'm a boarded feline specialist of the American Board of Veterinary Practitioners. That's the organization that does species specialty certification. And I've got mine, of course, in feline medicine. I'm on the board of directors of the American Heartworm Society. And I am the Feline regent for the American Board of Veterinary Practitioners. I'm certified in pain management and I'm also certified in veterinary acupuncture.

Justine Lee [00:03:03]:
It sounds like you are definitely the feline person to talk to. Now, first of all, I wanted to say, most cat owners, they can't really tell if their cat's in pain. Like unlike a dog owner, a dog may whine or cry or tremble. How can a cat owner tell if their cat hurts? And why is that different than a dog?

Mark Cousins [00:03:22]:
Boy, you're so right. It is much harder to tell if a cat hurts than if a dog hurts. Think about this. A dog, it's physical, right? Dogs are wimp, like we say in the cat world. They're going to cry, they're going to limp, they're going to have gait abnormalities. They'll growl if you touch a painful area. Overall, they're going to be a much more demonstrative species. Now, think about the cat. The cat is both prey and predator, right? So in the development of that species, they are genetically pre programmed to hide things. So they're much more subtle. So when a cat is hurting, when a cat shows pain, you're going to see behavioral issues more so than you're going to see physical issues because they're going to try their best to hide that. So here's what you'll see. The cat may not eat as much. They'll hide away. They'll hide in a closet or hide behind a piece of furniture. They'll sequester themselves away from life. They'll become less social. You'll see lack of grooming on these guys. Maybe you'll see mats in places where there weren't mats before because it hurts to move around and get to those places and clean themselves. Their gate change may subtly change when they're going upstairs. Or if they, for instance, want to jump on their favorite piece of furniture, they may not be able to make that jump anymore. So you won't notice them on that furniture, on that space that they like so much. They'll sleep more. They'll be less visible in settings where they were always out and about with the family because they're afraid that they're going to get hurt. One big thing cats will break litter box training because it may hurt them if they've got arthritis, to step in that litter box. And suddenly a cat who is extremely fastidious about using that litter box no longer does it. And of course, they'll be less inclined, as we said before, to jump up and down on furniture. So watch for subtle behavior changes in that cat, a dirty food area around the food bowl. If they've got dental pain, they won't chew their food appropriately and swallow it. They'll swing their head if they crunch on a tooth with a cavity, for instance. And they'll spray food all over the place. So these are very subtle. These are things you may not think about, but these are all behavioral signs that a cat hurts.

Justine Lee [00:05:43]:
Sure bringing that up, especially the kitty litter accidents. I've talked to you before about this, but he was probably about 15 to 16 years old when we moved into a new house. And all of a sudden my cat, who I've never had kitty litter problems with, started defecating outside of the litter box. And at first I thought it was behavioral because we had just moved into the house and he never had any problems in the previous house we lived in. And I was consulting with a bunch of veterinarians, a bunch of veterinary behaviorists, and I'm an emergency critical care veterinary specialist. So as soon as he started doing that, I started worrying about all the Er problems that we can see, like constipation or a medical problem or megacolon. And it turns out once I started him on a pain medication called Gabapetin by mixing it in a tiny amount of a palatable food. Obviously, it worked, right? He stopped defecating outside of the litter box. And that's the crazy thing. My litter box was pretty low entry. It was only about six inches, but it was just that six inches that was harder for him to get into. And the other thing that I noticed is as my cat aged, the amount of kitty litter in the box also made a difference. Some cats, they like really deep kitty litter, but some other cats, if they're really arthritic, they may feel more wobbly or more steady in it. So it really varies. What do you generally recommend kitty litter wise, for geriatric cats? Are there certain boxes that you recommend, obviously, besides treating the pain with a prescription medication from your veterinarian, are there certain things that a cat owner can do at home when it comes to litter boxes?

Mark Cousins [00:07:19]:
Boy. I tell you what, Dr. Justine. One of the easiest things you can do is lower that threshold in that litter box. Because if you think about it, there's the hip joint, there's the knee joint, and there's the tarsus or the ankle joint that cats have got to flex to get in that box. And there's the back end, the lumbar vertebra, where they've got to bend and squat. So if you can lower that litter box and make it easy for that cat to get in there, anything you can do to achieve that? Boy that's what you want to do. I think that probably makes a lot more difference into the comfort of the cat than the actual type of litter that's used physically, make it easier for that cat to get in there. Now, I've heard some people use ramps, and if they use ramps, you want to put a big old pad of litter in there. So it's not quite such a differential to get out of that box. But you just want to think about the physicality of that kitty walking into that box that makes all the difference in the world. And just as you found out it was a pain issue, it was a pain issue.

Justine Lee [00:08:18]:
Glad I was able to experience it myself, because it really made me empathetic. And I've told you this before. Older geriatric cats, when they come into the hospital, they're one of my favorite patients to treat because they're like they're kind of grumpy. But I absolutely love that. So it is really important that we make sure, especially as our cats become middle aged, that we're not missing those signs of your cat being in pain. All right? So kitty litter issues, difficulty jumping or thinking a little bit longer about jumping? Any other classic signs that we should focus on when it comes to identifying that pain in cats?

Mark Cousins [00:08:55]:
Boy look for dental pain. Boy how common is dental disease in cats? Right? So the cat that was a fastidious eater, there was no issues around the food bowl. Son of a gun. If you don't start to see pieces of food spread out all over the food bowl, all over the area around where the cat eats, here's what's happening. That cat is crunching down on a hard piece of kibble. And that kibble hits an area in the mouth that's painful, be it a gum disease, be it a cavity in that tooth, be it some other source of pain. And that cat shakes its head. And the pieces of that kibble that they've been crunching their mouth fly out of the mouth and litter the area around the food bowl. So if you see a cat who had a normally clean area around that food bowl, suddenly it's got kibble all over the place. Boy, bring that kitty to your veterinarian, let them do an oral exam and see if that cat's got some problems in that mouth.

Justine Lee [00:09:46]:
Thank you so much for bringing that up. I've also noticed when your cat chews their food at a weird angle and their head's at a weird angle, they're clenching on one side. And I really feel like we undervalue the severity of pain with dental disease in dogs and cats. If anyone's ever had tooth sensitivity and a piece of ice or a cold, cold sensation or a cold liquid hits it, it's like a shooting pain. If they've ever had a tooth fracture, they call their dentist during their emergency situation in the middle of the night. And oftentimes we're missing all this. And I see a lot of dogs with fractured teeth. I see cats that are with really severe dental disease. So really important to identify that dental pain.

Mark Cousins [00:10:28]:
I think you're 100% right. I think that is so underestimated in the general public how much pain I guarantee I look in some of these cats mouths and if it was us, we'd be running to the dentist at 02:00 in the morning. I mean, there's just no way we would ever put up with the amount of pain. Sometimes we ask our pets to put up with it. It's not that we don't want to do anything about it, it's that we don't recognize it.

Justine Lee [00:10:49]:
Exactly. I also did want to mention, please don't feel guilty if you all of a sudden notice that your cat is hiding. But I do encourage you to call your veterinarian, to call your emergency veterinarian also. And the main reason why is because oftentimes they have to alleviate the guilt that a lot of pet owners have. When I'm giving them a diagnosis, maybe it's end stage kidney failure. It's a diagnosis of cancer. And cat owners, dog owners are always asking me, did I miss some of the signs? Remember, like Dr. Cousins said, because cats oftentimes hide their signs, they don't want anyone taking over as being top cat. They often hide their signs. They're so stoic. So, again, they don't show their signs until they're pretty severe. So please don't feel guilty, but obviously we want to be able to recognize it so we can treat that. Now, we'll be right back with Dr. Cousins right after these messages.

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[00:11:52]:
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[00:12:38]:
Let's talk pets on PetLife radio. PetLife radio.

[00:12:41]:
Petliferadio.com.

Justine Lee [00:12:59]:
Welcome to er vet on Pet Life Radio. We've been talking with Dr. Mark Cousins about all things feline pain. We want to make sure we can tell when our cats are hurting. We want to make sure that we're not missing things that may be subtle, like making a mess when chewing. That often represents dental disease. Having fecal accidents outside of the litter box. That may mean that your cat has some osteoarthritis or some pain when they're walking into the litter box. So again, cats aren't quite as obvious with signs of pain the way a dog is. So we want to make sure we're watching for that. Now. Dr. Cousins, what's the difference in cats between acute and chronic pain?

Mark Cousins [00:13:38]:
That's a great question. I think we can sort of split up just some. We can use some examples of what might cause acute pain and what causes chronic pain. So acute pain obviously is something that happens quickly, right? From a veterinary perspective, these kitties that have acute pain, it may take a little bit of a different management strategy because theoretically that pain stimulus won't be around for a long time. For instance, an accident happens, a cat falls down from something and hurts a leg or hurts a paw or a surgery, a spay or a neuter or a dental procedure. Theoretically, things like accidents and medical procedures will cause, hopefully, short term pain. And we can manage that. We'll be giving kitties pain medicine for only a short period of time. So we'll call those acute. All right? But chronic pain is pain that a cat has had for a long time. And chronic pain can change things in a neurologic wiring of cats so that the chronic pain could be much worse over time or it can set up in a nervous system where it becomes much more difficult to deal with. And this type of pain can require a whole different strategy of pain management. So what are we talking about here? Old long standing dental disease like we were talking about in the previous segment, cats with really bad mouths. Not only will that require dental intervention, but it may require long term medical therapy. Like, for instance, Dr. Justine, you mentioned Gabapentin in your kitty. Some of these cats will require longer term medication with Gabapentin to try to relieve their dental pain. Osteoarthritis a big one in cats that are older. We'll talk about this, I hope, in a few minutes. Cats that are older that have osteoarthritis, these guys need to be on some kind of pain management strategy, often for life, so we can relieve their pain and make their quality of life a bit higher.

Justine Lee [00:15:37]:
Now, I will say I love Gabapentin. Not only is it a really good, safe pain medication, but it has what we call a really wide margin of safety, which means that you can safely give pretty high amounts, and we actually use this as a way of reducing anxiety or reactivity. In other words, if your cat doesn't like going to the vet or they're kind of mean or hissing a lot and really stressed out, it really helps a lot to have Gabapetin on board. In other words, talk to your veterinarian about it, because we usually give high dose Gabapetin the night before and then the morning of typically one to 2 hours before the actual cat appointment. So you really want to talk to your veterinarian about it. I'm a huge fan of Gabapentin for that reason. Now, I know there's a bunch of other different medications out there. Do you mind just talking to me about some of the different feline pain medications that are out there right now?

Mark Cousins [00:16:30]:
Sure, I'd love to. I'm going to start with one of the newest ones, and this is really exciting technology that's come to veterinary medicine, or I should say to feline medicine, and that's the use of monoclonal antibodies to break the pain cycle in cats. If you've ever seen these commercials on TV for human medication, and the medication ends in the letters MAB, that's a monoclonal antibody therapy. And there's tons of commercials about this particular technology in people. But this technology has come now to feline medicine. And there's new drugs out there that incorporate monoclonal antibodies which are safe and for the most part, extremely effective. And the really exciting thing is they can be used chronically to help break the pain cycle. In kiddies with chronic pain like osteoarthritis, we can use other medications like non steroidal, antiinflammatories in short term therapy protocols. This is drugs in the aspirin family. Now, don't use aspirin on your cat. I'm just saying it's in that family of drugs. And so these drugs can be used, these types of drugs. Again, I want to make sure I make this clear that are prescribed by your veterinarian. Don't reach in the cabinet to give your cat aspirin. But this family of drugs can be very effective in helping arthritis in cats. There's other families of drugs that will help build up the cartilage in the joints that's damaged. These are called glycosaminoglycans or gag gag drugs. There are omega three and omega six fatty acids, which can be added to food or can be given orally that also have some properties to relieve pain, chronic pain in the cat. So all these families of drugs can be used either by themselves or more importantly, together to solve long term management of pain in the cat. And again, this is something your veterinarian needs to get involved in. And this is called multimodal pain management strategy. And the use of several of these drugs in combination with each other can be very effective in helping your cats. Guys, cats don't have to have pain anymore. They don't have to suffer anymore. We can intervene and do a lot to satisfy these cats pain management strategy and to give these cats a good.

Justine Lee [00:18:45]:
Quality of life, oftentimes with acute pain. In other words, post surgical pain, maybe your cat was just spayed or neutered or had a dental procedure or had emergency surgery. We'll oftentimes send them home with buprenorphine, which is a type of opioid morphine like pain medication. And we usually give that either under the skin. We can oftentimes give that in the mouth, under the tongue. But we can also do that multimodal approach that Dr. Cousins talked about adding on a different pain medication on top of it. Now, as a toxicologist, I have to say you never ever give any kind of medication to your cat without talking to your veterinarian, your emergency veterinarian, or the ASPCA Animal Poison Control Center, because something that's safe in humans like Tylenol or cetaminophen. Well, one Tylenol can kill a cat, right? One ibuprofen non stertal antiinflammatory can actually result in severe kidney failure in a cat. So again, never ever give any of your human medications, even if they're over the counter to your cat, without talking to a veterinarian. There are so many safer medications you can give. Now, I will also say some owners can't pill their cats. Well, talk to your vet, talk to your veterinary technician. They can give you lots of clues on how to do it. I will say in one cat that I had, I'm embarrassed to say I've been practicing for 25 years. This one cat I just could not pill. I decided not to. My other cat, who, again, was on Gabapentin for pain, I just gave a tiny amount in a really palatable prescription critical care diet. It was just a tiny amount, but it was enough to get the medication in. You can also talk to your veterinarian about getting it compounded, and that's when we make it into a liquid or a pharmacy, we'll make it into a liquid, and some can even make it into certain flavors, like chicken flavored or something more palatable. So when in doubt, talk to your veterinarian about it. There's lots of great options. There's injections that last for several weeks. So you definitely want to talk to your vet about that.

Mark Cousins [00:20:48]:
Boy, the best medication in the world doesn't work if the cat can't take it.

Justine Lee [00:20:51]:
Right, exactly. Or if it's on the walls or under a sofa.

Mark Cousins [00:20:54]:
It's exactly right.

Justine Lee [00:20:56]:
Yes. All right. Now, I know we already talked about arthritis. Do cats really get arthritis? And how common is it, and how can I tell?

Mark Cousins [00:21:04]:
Boy, it is extremely common in the older cat. There are some studies, especially from North Carolina State University, that suggest that about 70% of cats over the age of nine years will manifest some X ray changes that are consistent with arthritis. Yes, it is very, very common. And that means that these kiddies that have this osteoarthritis will experience some sort of discomfort. There is a great website, Dr. Justine, if I can give your listeners this information. It's called cat OA checklist. Cat OA checklist. One word. That's all. One word. And there's a great little graphic, cartoon graphic. And you could see this kitty go up and downstairs, try to jump on furniture, et cetera. And it shows you what a normal cat does and what an abnormal cat does. And, boy, I would encourage everybody to take a look at that. If you even think your cat's having a problem, look at this little graphic and see if your cat doesn't fit any of these profiles. And if it does, please have a conversation with your veterinarian, because your kitty might have some osteoarthritic problems.

Justine Lee [00:22:15]:
Now, one question I wanted to ask. I know veterinarians, veterinary technicians will often use something called pain score or a Grimace score. Now, this is more designed for veterinary professionals, but do you mind just giving us a little bit of information about what is this? And we, as veterinary professionals, aren't even that good at identifying pain, right?

Mark Cousins [00:22:36]:
Sure. Yeah. I mean, that's absolutely true. I had this conversation with the veterinarians the other day about how important it is. Again, the cat's just a difficult species to evaluate pain in. So the scales that you referenced there's, gee whiz, there must be about six or seven of them. I like the Grimace Scale. I think it's easy to use. And basically what it is is you look at the face of a kitty, you look at its eyes, you look at its ears, you look at its whiskers, you look at the posture of the head and you try to determine from this if the cat is not only feeling pain, but how much pain that cat is feeling. And if the cat's, for instance, squinting the eyes, holding the head down, the whiskers are back, this cat's in a significant amount of pain. The cat should be wide eyed, ears to the front, whiskers out in an inquisitive posture. That's a cat that's comfortable. Anything less than that, between those two examples that I just told you, anything less than that are gradations of pain that this kitty may be feeling. It's an easy scale to use. Now, I will say that most of the time, this is a scale that's used in acute pain. We like to use it after, for instance, surgery. Is our patient comfortable? Is he experiencing any pain? Do we have to give opioids? Do we have to give non steroidals? Do we have to do anything else to this kitty to try to make it comfortable? So I think a lot of these scales are mainly for use in acute episodes of discomfort in our kitties, right. But chronically, again, I'm going to refer back to the behavior stuff that we talked about before. Is the cat hiding, is breaking, litter box training, et cetera. So these scales are extremely useful, and especially in the veterinary environment, I think they're extremely useful to try to determine the comfort of our patients.

Justine Lee [00:24:21]:
Thank you so much. Any last tips you want to leave with us when it comes to recognizing or treating that pain in our feline family members?

Mark Cousins [00:24:29]:
Yeah, I think what I'd like to leave our audience with is, please tell your veterinarian what's going on with your kitty, because the things that you think may be insignificant may send up a red flag in that history that we're taking from you to try to determine if your kitty's hurting. I can't tell you how many times people tell me, my cat's hurting, my cat's limping. And you put that cat in examination room and let it walk around, and it is 100% normal. Remember, cats high pain. So when they're in a situation that they're uncomfortable, for instance, a veterinary examination room, they're going to do their best to hide pain. But your history and your relating of what you're seeing at home is so very important to us to try to determine if your kidney has pain or not.

Justine Lee [00:25:14]:
Agreed. And I'm also going to mention, when in doubt, try to capture it on your smartphone for video because it's just adrenaline. The same thing happens with me. I go into the doctor after waiting two months to get that appointment, and all of a sudden my pain has gone. I'm like, I swear my shoulder has been hurting for two months. Right? So just the adrenaline and the cortisol release makes that pain temporarily disappear in the exam room. We do truly believe you, but we need as much information or even pictures or short videos, and when in doubt, try to crop the videos so we see the most important part.

Mark Cousins [00:25:48]:
Dr. Justine, one other thing I'd like to say. We talked about drugs a lot, but I also want to make sure that our owners understand that there's a lot of environmental things that they can do to help their kitties be comfortable. Put steps up to get up to your bed, to get up to their favorite perches, put their beds out in the warmth of the sunlight. Just do things in the environment to help the cat. And boy, one of the biggest things we can do, knock some of that weight off your kitty, get that cat nice and fit and trim. And boy, you'll see a big change in its behavior, a big change in its pain manifestation. So we've talked a lot about drugs, but there's a lot of environmental things you can do. Once again, your veterinarian can help you with that.

Justine Lee [00:26:26]:
Such a great point. Thank you so much for bringing it up. Just keeping your cat trim. And if you're not sure, you can always just literally Google the purina body condition score for cats, your cat should be a four. And I would say the majority of cats I see, at least in Minnesota, are probably like a seven at a nine body condition score. And so you always want to talk to your veterinarian about what we can do to get that weight off. There's different prescription diets, there's different ways that we can feed. So great, great information. So when in doubt, don't miss those signs of pain. Again, they may be subtle things like chewing abnormal or making a mess, having kitty litter accidents or defecating outside on a litter box, but so many environmental things you can do, so many safe pain medications that your veterinarian can talk to you about. Dr. Cousins, thank you so much. Love what you do. And thank you for being such a great feline family member advocate.

Mark Cousins [00:27:20]:
Well, thank you for allowing me to speak the gospel according to cats. I appreciate the opportunity.

Justine Lee [00:27:26]:
Thank you so much. Well, that brings us to the end of today's show. Find me@drjusteenley.com on Facebook or Instagram at Drjustine. Lee or email me your pet questions at drjusteen@petliferadio.com. With that, we're out of time. And we'd love to thank Dr. Mark Cousins and Mark Winter, our producer, for making this show possible. See you at the next episode.

[00:27:47]:
Let's talk pets every week on demand, only on petliferadio.com. Sam.

Timestamped overview:

00:00 Cats are subtle in hiding their pain.
05:43 Cat litter issues resolved by pain medication.
08:55 Cat may have dental issues with pain.
13:38 Distinguishing acute and chronic pain in cats.
16:30 New monoclonal antibody technology for feline pain.
22:36 Grimace Scale assesses cats' pain and comfort.
26:26 Keep your cat trim, consult veterinarian for help.
27:26 Gratitude for guests and sign-off details.

Questions:

1. What are some common signs of pain in cats, and how do they differ from those in dogs?
2. What is the difference between acute and chronic pain in cats, and how might the treatment strategies differ for each?
3. What are some common sources of chronic pain in cats, and how can these be managed in a multimodal pain management strategy?
4. Dr. Cousins mentioned a website called Cat OA Checklist for evaluation of cats with osteoarthritis. What are some behaviors or signs that may indicate a cat is experiencing osteoarthritic pain?
5. What are some feline-specific pain medications and treatment options that veterinarians might recommend for cats with chronic pain?
6. How do feline pain scores like the Grimace Scale help veterinarians assess pain in cats, particularly in the case of acute pain?
7. Dr. Cousins emphasized the importance of environmental factors in managing a cat's pain, such as maintaining a healthy weight and making environmental adjustments. What are some specific environmental adjustments cat owners can make to help their cats with chronic pain?
8. Dr. Cousins mentioned that chronic dental disease is a common source of pain in cats. What are some signs that might indicate a cat is experiencing dental pain, and what treatment options are available for this condition?
9. In the episode, reference was made to utilizing Gabapentin for pain management in cats. How does this medication work, and in what situations might it be prescribed?
10. How can pet owners effectively communicate signs of pain they've observed in their cats to their veterinarian? What are some helpful strategies, such as capturing videos or photos, to aid in this communication?

Key topics and bullets:

Primary Topic: Introduction to Feline Pain
- The challenges of identifying pain in cats
- The differences between identifying pain in cats versus dogs
- Signs of pain in cats, such as changes in behavior and grooming habits
- The importance of recognizing and addressing feline pain
Primary Topic: Acute vs. Chronic Pain in Cats
- Examples of acute pain in cats, such as accidents and medical procedures
- Management strategies for acute pain
- Chronic pain conditions common in cats, such as dental disease and osteoarthritis
- The need for a different pain management approach for chronic pain
Primary Topic: Feline Pain Management
- Overview of different types of feline pain medications, including monoclonal antibodies, non-steroidal anti-inflammatories, and other pain relief drugs
- The importance of working with a veterinarian to develop a multimodal pain management strategy
- Tips for administering medications to cats, including alternative options for cats that are difficult to pill
- The significance of medication safety and never giving human medications to cats
Primary Topic: Osteoarthritis in Cats
- Prevalence of osteoarthritis in older cats
- Examination of the Cat OA checklist as a tool for identifying signs of osteoarthritis in cats
- Discussion of the severity and implications of osteoarthritis in feline patients
Primary Topic: Feline Pain Scoring
- Explanation of pain scoring in veterinary medicine, including the use of the Grimace Scale
- Importance of utilizing pain scoring techniques in acute pain situations
- Challenges and considerations when evaluating pain in cats
Primary Topic: Environmental Care for Cats with Chronic Pain
- Non-pharmacological strategies for managing feline pain, such as environmental changes and weight management
- The impact of environmental factors on a cat's comfort and pain levels
- Encouraging a healthy body condition score in cats for overall well-being and pain management
Primary Topic: Conclusion and Advocacy
- The significance of pet owner communication with veterinarians regarding their cat's health and behavior
- The use of video and other evidence to capture signs of feline pain for veterinary evaluation
- The role of pet owners in advocating for their feline family members and being proactive in addressing pain issues
These are the primary topics and sub-topic bullets based on the content from the transcript. Let me know if you need further details or adjustments.

Clip finder: Quotes, hooks, and timestamps:

Understanding Feline Pain: "So when a cat is hurting, when a cat shows pain, you're going to see behavioral issues more so than you're going to see physical issues because they're going to try their best to hide that."
— Mark Cousins [00:04:02 → 00:04:13]
Easing Mobility for Aging Cats: "One of the easiest things you can do is lower that threshold in that litter box. Because if you think about it, there's the hip joint, there's the knee joint, and there's the tarsus or the ankle joint that cats have got to flex to get in that box. And there's the back end, the lumbar vertebra, where they've got to bend and squat. So if you can lower that litter box and make it easy for that cat to get in there, anything you can do to achieve that? Boy that's what you want to do."
— Mark Cousins [00:07:21 → 00:07:47]
Recognizing Feline Dental Issues: "If you don't start to see pieces of food spread out all over the food bowl, all over the area around where the cat eats, here's what's happening. That cat is crunching down on a hard piece of kibble. And that kibble hits an area in the mouth that's painful, be it a gum disease, be it a cavity in that tooth, be it some other source of pain. And that cat shakes its head. And the pieces of that kibble that they've been crunching their mouth fly out of the mouth and litter the area around the food bowl."
— Mark Cousins [00:09:05 → 00:09:34]
Elevating Cat Dining Experiences: "Elevate your cat's eating experience with the cat tree tray. The cat tree tray keeps your cat's food off the floor and conveniently located on the cat tree."
— Mark Cousins [00:11:55 → 00:12:04]
Understanding Acute vs. Chronic Pain in Cats: "So acute pain obviously is something that happens quickly, right? From a veterinary perspective, these kitties that have acute pain, it may take a little bit of a different management strategy because theoretically that pain stimulus won't be around for a long time... But chronic pain is pain that a cat has had for a long time. And chronic pain can change things in a neurologic wiring of cats so that the chronic pain could be much worse over time or it can set up in a nervous system where it becomes much more difficult to deal with."
— Mark Cousins [00:14:26 → 00:14:47]
Advancements in Feline Pain Management: "And the really exciting thing is they can be used chronically to help break the pain cycle. In kiddies with chronic pain like osteoarthritis, we can use other medications like non steroidal, antiinflammatories in short term therapy protocols. This is drugs in the aspirin family. Now, don't use aspirin on your cat. I'm just saying it's in that family of drugs. And so these drugs can be used, these types of drugs. Again, I want to make sure I make this clear that are prescribed by your veterinarian. Don't reach in the cabinet to give your cat aspirin. But this family of drugs can be very effective in helping arthritis in cats."
— Mark Cousins [00:17:08 → 00:17:48]
Senior Feline Health Concerns: "There are some studies, especially from North Carolina State University, that suggest that about 70% of cats over the age of nine years will manifest some X ray changes that are consistent with arthritis."
— Mark Cousins [00:21:07 → 00:21:21]
Assessing Feline Pain: "I like the Grimace Scale. I think it's easy to use. And basically what it is is you look at the face of a kitty, you look at its eyes, you look at its ears, you look at its whiskers, you look at the posture of the head and you try to determine from this if the cat is not only feeling pain, but how much pain that cat is feeling."
— Mark Cousins [00:22:51 → 00:23:09]
Understanding Feline Pain: "Yeah, I think what I'd like to leave our audience with is, please tell your veterinarian what's going on with your kitty, because the things that you think may be insignificant may send up a red flag in that history that we're taking from you to try to determine if your kitty's hurting."
— Mark Cousins [00:24:29 → 00:24:47]
Improving Cat Well-being: "We talked about drugs a lot, but I also want to make sure that our owners understand that there's a lot of environmental things that they can do to help their kitties be comfortable. Put steps up to get up to your bed, to get up to their favorite perches, put their beds out in the warmth of the sunlight. Just do things in the environment to help the cat."
— Mark Cousins [00:25:50 → 00:26:07]