Animal Behavior Case of the Month

Sun-A Kim Clinical Animal Behavior Service, Veterinary Medical Teaching Hospital, Chungbuk National University, Korea

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 DVM, MS
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Melissa J. Bain Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA

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 DVM, DACVB, MS, DACAW

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Signalment

The patient was a 12-year-old 5.1-kg castrated male domestic shorthair (DSH) cat.

History

The patient was presented for defecating, and urinating outside its litterbox, with urine deposited on vertical and horizontal surfaces. It also displayed aggression toward one of the household cats.

The cat was rescued and bottle-raised by its first owner. This owner married its current owner seven years before the presentation; the original owner passed away five years after the marriage. At the time of presentation, the cat lived with 2 other cats, a 20-year-old spayed female DSH and a 16-year-old spayed female DSH. Both of these cats had marginally-managed urinary incontinence. Before the owners’ marriage, the cat was raised as an indoor/outdoor cat by the male owner for 5 years, with access to an indoor litterbox for times when its outdoor access was restricted. After the owners married, they moved to a new home, at which time the cat became an indoor-only cat. Three covered litterboxes filled with unscented clay clumping litter were provided in the home. They were scooped twice daily, and completely cleaned with mild soap and water every 2 weeks. Two were upstairs in the laundry room, and 1 was downstairs in the bathroom. The patient’s horizontal urination and defecation outside of the litterbox started a few months after moving into the home after the previously-uncovered litterbox was covered. Large puddles of urine were found once weekly on the sofa, carpet, rugs, and bathmats. Formed feces were found in the bathtub about once a month.

The patient’s vertical urine marking on walls and furniture started immediately after moving into the current home. The problem worsened when the cat started to be chased by the oldest cat and worsened again when the original male owner passed away. At the time of presentation, the vertical urine marking occurred twice weekly downstairs, where the other 2 cats resided. When the owner witnessed these behaviors, she verbally disrupted the patient and cleaned the soiled areas with an enzymatic cleaner (Nature’s Miracle; Spectrum Brands).

The patient avoided the other household cats and did not engage in any affiliative behaviors. Initially, all cats were fed in the kitchen twice daily. However, the oldest female cat chased and bit the patient multiple times while the cat was eating. The patient reacted by hissing, with flattened ears, and avoidance. If the cats were in the same room and the patient couldn’t avoid the oldest female cat, the cat hissed, swatted, and bit the other cat.

The patient was seen by the referring veterinarian 2 weeks before presentation for a full medical workup, including radiographs, CBC, serum chemistry panel, thyroid panel, urinalysis, and urine culture/sensitivity. There were no significant findings. The owner’s goal was for the patient’s house-soiling problems to stop before renovating her house.

Physical Examination Findings and Laboratory Results

Aside from a body condition score of 6/9, no abnormalities were noted.

Diagnosis

Medical differentials for house-soiling include diseases that cause urinary-related disease, such as feline idiopathic cystitis, urinary tract infection, and urolithiasis; metabolic disorders like diabetes or chronic kidney disease; gastrointestinal disorders such as chronic enteropathy or megacolon; and any painful conditions like an orthopedic disease.14 Based on the unremarkable results of the physical examination and diagnostic tests, along with the presenting history, primary medical causes were considered less likely. Behavioral differentials for the house-soiling included urine marking and inappropriate toileting behavior.1,47 Urine marking was diagnosed because the patient was seen spraying small amounts of urine on socially significant vertical locations in a standing posture with its tail up and quivering.1,4,6 Possible underlying motivations for urine marking behavior include territoriality, environmental or routine changes, and anxiety relating to other cats.1,4,6 Considering that the urine marking occurred only downstairs where the 2 senior urinary-incontinent cats resided, the urine marking behavior was likely due to the social conflict with the other cats. The possible aggravating factor for the urine marking behavior included other sources of stress, such as moving to a new home with a new owner and other cats, losing access to the outdoors for elimination and stimulation removal of the preferred open litterbox, and death of a bonded-owner.2,8,9

Inappropriate toileting behavior was diagnosed because the patient was seen depositing large quantities of urine horizontally on fabric materials while squatting, and feces had been found in the bathtub. Behavioral differentials for inappropriate toileting behavior included litterbox aversion, substrate or location aversion, substrate or location preference, and social conflict.1,2,7 Litterbox aversion may have resulted from its preferred uncovered litterbox being replaced with a covered litterbox. Also, for the first 5 years, the patient preferred eliminating outdoors unless restricted by weather conditions. Due to these reasons, a component of litterbox aversion was diagnosed. Furthermore, the urination was only on fabric materials, and the defecation was only in the bathtub, which indicated potential substrate preference but not location preference or aversion.

The patient’s aggression toward the oldest female cat had behavioral differentials of fear, territorial, offensive, pain, or status-related aggression.10 Pain was considered unlikely based on physical examination and clinical history. The aggression was observed only in the oldest female cat(chaser cat)’s living quarters, and the chaser cat showed territorial behavior but not the patient.11 The patient’s behaviors of running away from the oldest cat, arched back with piloerection, ears back, dilated pupils, and hissing were consistent with fear.10,12 Therefore, the motivation for the intercat aggression toward the oldest female cat seemed to be due to fear.1012

Treatment

Environmental modifications included: separating the patient from the 2 senior cats by feeding the patient upstairs; providing more enrichment in its favorite room including food-dispensing toys, more perches, and hiding places; interacting more with the patient; and setting up an outdoor cat confinement system in their backyard to help reduce its stress of being limited indoors.10,13 Installing synthetic feline-appeasing pheromone diffusers (Feliway; CEVA Sante Animale) were discussed, but the owner declined.14,15 There is limited evidence to support the strong recommendation of this treatment.16

To treat the patient’s inappropriate toileting, the key goal was to make its litterboxes more appealing so that the patient would be more likely to eliminate only litterboxes. Recommendations included providing a bigger uncovered litterbox filled with unscented litter, and placing it in the upstairs bathroom, near its favorite room.17 If the patient didn’t use the new litterbox, then an additional litterbox filled with fabric, such as towels, was to be added. The litterbox hygiene was to be continued. Limiting access to previously soiled areas and not leaving fabric materials on the floor were recommended. Lastly, previously soiled areas were to continue to be cleaned with an enzymatic cleaner.

Studies have found fluoxetine to be highly effective in the treatment of urine marking due to its effectiveness in lowering stress and anxiety.18,19 Fluoxetine chewable tablets (Reconcile; PRN Pharmacal) were prescribed at a recommended dose of 4 mg, q 24 h (0.78 mg/kg) for the urine marking behavior.18,20

Systemic desensitization and counterconditioning (DS/CC) was recommended for both the patient and the oldest female cat.10 DS/CC is achieved through gradual exposure to the stimulus paired with something pleasurable in the presence of the stimulus. The owner was instructed to start DS/CC with the female cat behind a baby gate at the foot of the staircase, and the patient at the top of the staircase. The presence of one another was to be paired with palatable food. Over several sessions, the cats were to be brought gradually closer together, repeating this same process.

Follow-up

In the first week, the patient started eliminating in the uncovered litterbox exclusively in the upstairs bathroom. The owner thought the patient appeared to be more relaxed and playful when playing with toys than before. In the second week, no evidence of urine-marking or inappropriate toileting behaviors was detected. New food-dispensing toys were introduced. As instructed, DS/CC was instituted, utilizing the gate and high-value foods, where the patient was fed at the top of the staircase and the oldest female cat at the bottom of the staircase, divided by the baby-gate. DS/CC progressed well, allowing them to be a few steps closer to each other, separated by the baby-gate.

After three months, the owner had the house repainted over five days, at which time the patient mostly remained in its favorite room, with no return of problem behaviors. Unexpectedly, the oldest female cat passed away, so the DS/CC was discontinued. Even after the cat died, the owner chose to continue administering fluoxetine 4 mg, q 24 h (0.78 mg/kg) because she did not want to take the risk of the patient returning to urine marking behavior. Six months after the initial appointment, the owner reported that the patient was using its uncovered litterbox without any inappropriate toileting or urine marking behaviors and was happy and engaged when playing with toys.

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