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Caring for older cats – Part 2 – helping your feline through old age

Did you know that cats age the equivalent of 24 human years in their first 2 years of life?  After that, each cat year is about equal to 4 human years.  So my 18 year old Maddy cat is the same age as my 88 year old grandmother.  Doing that calculation helps put her age in perspective, and makes you wonder, am I taking care of her as I would care for my grandmother?  In my last blog I talked about some of the signs that your cat may start to show as they get older.  Observations such as changes in behaviour, toileting issues or changes in sleep patterns are all relatively common in older cats, but could actually indicate an underlying medical condition.  Any changes in your ageing cat should be discussed with your vet so that if there is any concern, the appropriate diagnostic tests can be run and treatment can be started if necessary.  But if you and your vet decide that your older cat is physically well, there are still lots of things that you can do to help them age a bit more gracefully. Give them a nail trim Most cats, especially those that go outside regularly, don’t need (and don’t want) their nails trimmed.  Older cats, however, don’t tend to need them much for hunting, tree climbing or fighting with their neighbours.  Although feline claws naturally shed with daily activity, the nails of older, less active cats tend to get overgrown and can even grow all the way around and into the pad of the foot, a very painful condition.  Even if they’re not overgrown, they still frequently get stuck on the sofa or their bedding, particularly if the cat suffers from arthritis and has limited movement.  Trimming the claws is relatively straightforward and most of the time you can do it at home.  Ask your vet or vet nurse for a demonstration if you are unsure. Give them a toilet Would you want your 88 year old grandmother to have to go downstairs, out the back door and down the garden to use an outside loo in the middle of the night?  Do your older cat a huge favour and give them a litter tray in an accessible location.  Make it big and uncovered with low sides if possible, as these are easier to use for older arthritic cats.  If you have lots of stairs, consider one on each floor.  Not only will they appreciate the shorter trip and be less likely to have accidents on your carpet, but many older cats have trouble going through cat flaps so the less they have to use it, the better.  Cleaning the litter tray also gives you an opportunity to notice any changes in urine volume or blood in the stool. Give them a (gentle) brush Old, stiff cats often find it difficult to groom themselves as much as they used to.  Their bodies just don’t bend that way anymore, or if they do, it hurts.  They also tend to sleep more and that leaves less time for activities like grooming.  I think they also just plain forget sometimes.  Cats that don’t groom themselves, even those with short hair, can get matted fur and this hurts.  By brushing your cat daily, you can help them remove dead hairs and dirt and prevent painful matts.  Long haired cats need a more thorough groom.   Be gentle though, particularly over the spine and legs as these are the areas most likely to be affected by muscles loss or arthritis.  While you’re at it, take a look for fleas or any new lumps or bumps on the skin and bring these to the attention of your vet.  If your cat objects, try a grooming glove or very soft brush rather than the typical wire cat brush.  If they still won’t let you near them, speak with your vet about a possible underlying cause and consider having some of the fur trimmed and matts removed by a professional with clippers.  Whatever you do, never try to cut out closely matted fur with scissors – I have seen some horrendous injuries as a result and it is simply not safe. Give them what they want to eat You may notice that your older cat doesn’t have the same appetite that he used to.  While this can be due to a decreased sense of smell or taste with age, it could also be the result of an underlying medical problem so it’s very important to speak with your vet.  If your older cat ever needs some encouragement to eat, here are some things that you can try if your cat finds eating to be a bit of a chore:
  • Warm the food up slightly (beware heating cat food in the microwave, it gets very hot very quickly!) to just below body temperature.  Warm food generally smells and tastes better.
  • Giving your cat a good stroke before or sitting with them during a meal can encourage them to eat.
  • Don’t leave food sitting out all day - if they don’t eat it within an hour pick it up and put down fresh food at the next meal.
  • Trying a new brand or flavour can encourage them to eat.  But at the same time, try not to leave out several bowls of different foods for them to choose from as this can be overwhelming.
  • Wet food is almost always more palatable than dry, especially for older cats who may have dental problems, so consider changing the type of food you offer.  You could also try adding a bit of water to the food or mashing it with a fork.
Make it easy for them
  • If your cat prefers to sleep on your bed, put a chair next to it so they can use it as a step to get up and down.
  • Consider keeping a food and water dish in the bedroom or just outside it so they don’t have to go far for the things they need.  Older cats (particularly those fed dry food) can become dehydrated easily.
  • Keep their environment quiet and warm, and try to avoid letting the children grab them at every opportunity.
  • Offer a horizontal scratching post instead of a vertical one, and don’t forget, they may be old but they still need mental stimulation.  They may choose to play with different toys as they age, but things like open cardboard boxes or bags can give them something to investigate and a large catnip toy can be batted and kicked around the house.
  • Try to keep their routines as constant as possible, as older cats can take great comfort in knowing that things always happen when and how they’re supposed to happen.
As your cat starts to age, take a good look at their daily activities and see if there is anything you can do to make things a little bit easier on them.  Your vet or vet nurse may have other suggestions, so it’s always a good idea to ask for advice.  You could even try asking elderly members of your own family for ideas – you might be surprised by what they come up with!  And remember, if you wouldn’t want your 88 year old grandmother doing it, you probably shouldn’t expect your 18 year old cat to do it either.
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A vet in Delhi day 7: summary and conclusion

[caption id="attachment_3824" align="aligncenter" width="560"]ASHA gave me the opportunity to give a talk to their community health volunteers on rabies ASHA gave me the opportunity to give a talk to their community health volunteers about rabies[/caption] I've spent my final day in the slum and it's time to draw it all together and reach some conclusions. What's it all been about, what have I achieved, and what's going to happen next? First, to explain: the rationale behind my work has primarily been human health. It's shocking that rabies is still a major killer in India, despite the fact that it's completely preventable. If 70% of the street dogs in an area are vaccinated, the disease dwindles and disappears to insignificant levels. Surely this is a goal that is achievable? The current estimated incidence in India of around 3 deaths per 100000 people per year means that over 20000 people, mostly children, die unnecessarily every year. In a slum like Mayapuri, with a population of 12000, there's probably around one death every three years. Feedback from my questionnaire suggested that this may be close to the truth. Rabies is common enough to be a constant threat, but rare enough that it's easy for people to forget about it. Yet it is such an horrific, unnecessary death that everything possible must be done to prevent even one fatality. ASHA deals effectively with many health and welfare issues in the slums, vaccinating children with BCG, MMR, Hepatitis, Tetanus and Polio: before ASHA arrived 15 years ago, no babies were being vaccinated – the uptake is now 100%.  ASHA also treats adults for TB under the DOTS programme, and offers a range of birth control methods. There's no doubt that the charity's work has transformed the lives of the slum dwellers. But what about rabies? When I asked this question last year, it seemed that it was a bit of a grey area: ASHA is so busy with other priorities that it's easy for rabies to slip under the radar. When I discovered this, I felt that there was an opportunity for me to use my background as a vet to look into the issue when visiting the slum with a group of volunteers from my local church. Mission Rabies – who are already in the process of vaccinating millions of dogs around India – do not have an immediate plan to focus on the Delhi area, but they were exceptionally helpful in assisting me with this project. They drafted a questionnaire for me to use while here, and they advised me on important aspects such as informed consent and male/female interpreters. So what did I discover? Well, I found out how difficult it is to do social research. I had thought I might gather several hundred questionnaires over 3 days, but the process took longer than I had expected: up to 15 minutes for each interview via an interpreter, then time spent seeking out the next candidate. I ended up with just 40 completed questionnaires: not as many as I'd have liked, not enough to be significant in a formal sense, but still perhaps enough to gather valuable feedback about the subject. What did I learn? First, I discovered some interesting socioeconomic facts.
  • 75% of households live in just one room, shared between an average of four people: no kitchen, no bathroom, no hot water
  • 95% of slum dwellers own a mobile phone
  • 90% own a television
  • 65% own a bicycle.
Second, I discovered that street dogs are a significant part of the slum community, with an average estimate of one dog per 17 humans (the range was one per 5 to one per 20 people). The only way to get a more accurate figure would be to do a detailed dog census, which would be a major logistical challenge in itself, but the estimates are enough to make the point that there is a substantial population of dogs.. While only 15% of people said that they “owned” a dog, 57.5% said that they feed local dogs at least once a week. This ties in with the reported attitudes to dogs: 40||% said that they “liked” dogs, 15% were indifferent t while 45% of interviewees said that they “did not like dogs” (presumably the latter never feed them). Third, I investigated the local people's knowledge about rabies. I found a low level of awareness of the disease. 80% of respondents had not heard of rabies, and only half of the 20% who said that they had heard of rabies were able to explain the disease to someone else. Some people thought that rabies would make them “bark like a dog”. Furthermore, only 45% of people thought a dog bite could be fatal, with 55% of people disbelieving this. There's clearly a need for community education about rabies in order to prevent future cases. More positively, despite the lack of knowledge about rabies, 90% of people would go to hospital if bitten by a dog (where they would be given the post-exposure rabies vaccination). As well as doing this, some people would take other action, including putting red chilli powder on the wound, and resorting to “witchcraft”. The 10% who “did not know what to do” if they were bitten by a dog are worrying: they would be very vulnerable to developing clinical rabies if bitten. What's going to happen next? If nothing is done, nothing will happen. The situation will remain the same, and people will continue to die of rabies at a rate of around one person every three years. Clearly this cannot be allowed to happen. ASHA already have an effective network of community health volunteers on the ground, keeping an eye on the health of inhabitants in their local area, and passing on information to them about health and disease using handouts and flash cards. On my last day in the slum, ASHA kindly arranged for me to give a presentation to a dozen community health volunteers from Mayapuri and another nearby slum. I was able to pass on the initial results of my survey, and to discuss the challenge of rabies awareness with them. I explained the issues of rabies and street dogs in detail, and handed out several hundred picture-based colour information leaflets about “Getting Along With Dogs” (designed by Mission Rabies). These volunteers will go back to their own areas and will talk to local parents and children, stressing the importance of avoiding dog bites by interacting appropriately with dogs. They'll also mention rabies, the importance of wound cleaning and the need for a visit to a medical centre if a dog bite does happen. So far, so good. But what about the other 58 slum areas (housing 400000 people) under ASHA's care? And what about the other 500-plus slums (with millions of inhabitants) that ASHA has not yet reached? There is a massive population in Delhi that's still unaware of the ongoing threat of rabies. What can be done to reach them? This is where Alliance of Animals and People (AAP) may come in. In an earlier blog, I outlined a visit I made at the start of my Delhi trip to one of their slum programmes in a different part of the city. AAP has a stated aim of working with NGO partners to help children in need: their founder, Bondana Dutta, is an ex-regional director of CRY, a major children's charity. The concept is simple: AAP sends a volunteer to nominated slums to teach groups of children about awareness of the risk of dog bites and the importance of rabies prevention and treatment. AAP also works with local communities to lobby municipal authorities to provide other helpful measures such as rabies vaccination and population control of street dogs. Could an AAP staff member visit ASHA slums like Mayapuri to give regular classes to children, raising awareness of these issues and helping to prevent future cases of rabies? If this generation of young people are educated now about the subject, they will soon grow into a well-informed generation of adults, and the entire slum community will then become rabies-aware. This suggestion may sound sensible, but it isn't always so easy on the ground. In particular, funding is a challenge. AAP staff members are already over-stretched. If extra work was scheduled (such as visiting ASHA slums), a new staff member would need to be recruited, costing at least €3000 per year. And a new initiative like this might also incur extra costs for ASHA. If funding is not there, new projects like this cannot happen. So what do we do about it – people like you and I? Finish this blog and walk away? Or take some positive action to help? I realise that I have just been on the front line of the slums, which makes it all very real and urgent to me. But I am heading home with a determination to follow this through by making a commitment to fund-raise for ASHA and for AAP. Over two thousand people have been viewing these blogs: if each of you donated just €2 per year, that would be enough to provide the financial resources to kick start this type of programme. With a small gift from each of us, the first steps could be taken to eradicate rabies from ASHA slums, and to help the welfare of the slums' street dogs at the same time. I'm happy to help to coordinate a plan like this, but I need your help.Visit our other ASHA-focussed blog and click on the "Donate" button on the top right of the page if you want to make a small donation. And watch this space: I'll let you know what happens.  
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A vet in Delhi – day 6: a selection of photos

I've been busy this evening working through my survey results so that I can give a presentation to ASHA about them tomorrow, so I have not had time to write a blog. But to give a sense of the past day here, I've put together a selection of photos. The captions should be enough to tell their stories.... [caption id="attachment_3811" align="aligncenter" width="560"]01-DELHI 828 Local children interacting with a street dog. Excitable, uncontrolled close contact like this carries a high risk of dog bites. Education of the children in dog-human interactions could reduce incidence of dog bites.[/caption] [caption id="attachment_3812" align="aligncenter" width="392"]02-DELHI 826 This street dog seemed friendly, but he has a track record of biting children such as the girl pictured below[/caption] [caption id="attachment_3813" align="aligncenter" width="374"]03-DELHI 825 This girl was bitten on her right forearm a few months ago[/caption] [caption id="attachment_3814" align="aligncenter" width="560"]04-DELHI 824 The scar is hard to see now but at the time she needed hospital treatment with post rabies exposure vaccinations[/caption] [caption id="attachment_3815" align="aligncenter" width="560"]08-DELHI 787 This pup is being comforted by his mother after a frightening incident that I witnessed[/caption] [caption id="attachment_3816" align="aligncenter" width="560"]09-DELHI 784 The pup had been barking ferociously at a local goat[/caption] [caption id="attachment_3817" align="aligncenter" width="560"]10-DELHI 783 The goat was not impressed, giving a demonstration of punishment by butting[/caption] [caption id="attachment_3818" align="aligncenter" width="560"]27-DELHI 646 ASHA works in the community, spreading information via a network of women from all over the area who come to the ASHA centre regularly to meet up and share knowledge[/caption] [caption id="attachment_3819" align="aligncenter" width="560"]30-DELHI 610 The last questionnaires were done today, and the rabies/ street dog survey is now being analysed[/caption]

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A vet visits a Delhi slum day 5 – asking about dogs in the world’s biggest motor workshop

[caption id="attachment_3778" align="aligncenter" width="614"]Mayapuri is like a thousand garage workshops lined up end-to-end, in the open air Mayapuri is like a thousand garage workshops lined up end-to-end, in the open air[/caption] When I return to the slum each morning, I'm repeatedly reminded of a type of hell: there is mud, grime, and two other aspects that are difficult to convey via a blog - a strong “workshop” smell (oil, fumes, solvents etc), and most of all, NOISE. Maypuri is known as the biggest motor workshop in the world, and wherever you go, there are deafening sounds of metal beating against metal, metal drilling through metal and engines roaring. Unemployment here is not the highest in the world, at 20%: there is work, but it's tough, noisy, dirty work. Beat-up vehicles litter the streets, where they are picked at by people with spanners, screwdrivers and sledge hammers. I saw a dumper truck being reduced from a slightly bashed but otherwise perfect vehicle to absolutely nothing at all after being picked at all day by a small army of hard working labourers. [caption id="attachment_3794" align="aligncenter" width="323"]This child has a magnet on the end of a stick: instead of going to school she spends her days collecting metal This child has a magnet on the end of a stick: instead of going to school she spends her days collecting metal[/caption] Nothing is wasted. People collect 5cm lengths of wire, random nuts and bolts, springs and anything at all. Children as young as five are sent by their parents to search for bits of metal, using wooden sticks with big magnets on the end. The oily grime on their skin is permanent: hot showers or baths don't exist here. I have found myself questioning my priorities as I walk through them holding a questionnaire to ask about the stray dogs. Many of them seem bemused: nobody has ever asked them about dogs before. Why dogs, when people are clearly suffering? My answer to myself is that why not dogs as well as people? For a small amount of extra effort, animals can be looked after too, and where animal welfare is good, there is a positive feedback loop, with people feeling better about themselves, dogs being friendlier, and the whole atmosphere improved. [caption id="attachment_3789" align="aligncenter" width="800"]Interviewing people in a different language is time consuming and difficult Interviewing people in a different language is time consuming and difficult[/caption] I had a female interpreter with me today, which made it possible for me to talk to women in a much more relaxed way. It still takes a long time to complete this type of survey: there are strict rules about gaining informed consent by explaining it all in detail, with signed forms in duplicate, one to be left with the person. Then the questions are rarely “yes” or “no” - there's always a few minutes of chat before the interpreter passes on the condensed version of the answer. I had imagined I might complete a hundred questionnaires a day: the reality is more like ten or twenty. I'm just gathering in results just now: I'll need to analyse the data and come up with some sort of conclusion before I'm done here. One interesting side effect of doing the survey is that I've spent considerable periods out and about in different parts of the slum, and I've seen aspects that I'd have missed otherwise. Some of it is predictable – the poverty, the lack of infrastructure (many of the drains are open, and there's no rubbish collection system), and the dangers people suffer every day (that railway...) I previously mentioned a woman who had lost her legs to the train as a child. Today I wasn't surprised to meet a dog with a hind leg missing: neatly sliced off by a train last year. It's a small miracle that he survived, with no veterinary treatment at all. [caption id="attachment_3786" align="aligncenter" width="480"]This dog is missing a hind leg after being hit by a train This dog was missing a hind leg after being hit by a train[/caption] There have been other unexpected surprises – the open friendly nature of the folk here – you'd think they might resent this wealthy foreigner with his fancy camera asking strange questions about worthless street dogs. There's not much  negativity: smiles and welcomes are the upfront response (although who knows what's said or thought privately?) And there have been some bizarre sights too: a man with a Pug on a leash, walking the dog along the railtracks. Where did he come from? What's going on there? [caption id="attachment_3782" align="aligncenter" width="347"]A man with a Pug in the slum A man with a Pug in the slum[/caption] And I was astonished to see a pet white rabbit hopping around: when I commented on it, a boy came out and picked it up – it's his pet.  [caption id="attachment_3784" align="aligncenter" width="300"]10-DELHI 503 This rabbit was hopping close to the rail tracks[/caption] [caption id="attachment_3783" align="aligncenter" width="160"]09-DELHI 504 The rabbit's owner[/caption] The most astonishing encounter that I had today was nothing to do with animals: I met an eight year old girl, who's called Poonja. There's a clue to her story in her name: she's called after the Poonja Express, an early morning train that whizzes past every day. Eight years ago, somebody on that train gave birth to a baby girl, and in this land of high dowries and even higher expectations, she was not wanted, so she was flushed down the train toilet. Somehow, the baby was still alive after landing on the train tracks, and some people from the slum found her as they went about their morning ablutions. They brought her into their home, kept her warm, fed her and loved her. [caption id="attachment_3787" align="aligncenter" width="320"]Poonja with her adopted father Poonja with her adopted father[/caption] The charity that I'm here with, ASHA, heard about this, and realising that the couple who'd rescued her didn't even have enough funds to feed themselves, helped them financially. Poonja is now going to primary school, and she visits the ASHA community centre every afternoon for an after-school club. With luck, she'll even end up going to university. ASHA is the Hindi word for “hope”, and Poonja is a living emblem of the value of their work. I just have one or two more days of data collection to do here, then I'll be sitting down to input it into a spreadsheet to try to produce some sort of analysis. I'll be sharing this with ASHA, Mission Rabies, AAP and others. What happens after that is still an open question but one thing is certain: Mayapuri has become a part of my consciousness which will never go away.
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A vet visits a Delhi slum day 4: getting down and dirty with the questionnaire

[caption id="attachment_3773" align="aligncenter" width="480"]Rubbish tips form the basis of most street dogs' nutrition here Rubbish tips form the basis of most street dogs' nutrition here[/caption] We are staying in the YWCA close to Delhi city centre, so every morning we are collected by a minibus and dropped at the slum. I was faced with the first shock of the day as soon as I stepped out of the minibus. Most street dogs lift their heads to look at you as you walk past: this young one didn't, so I stopped to get a better look. I called to him, then I gently touched him but he didn't move. I picked up his hind foot, aware that I could be bitten if he was frightened, but he remained motionless. He was still breathing, but he was unconscious: he was dying.

01-DELHI 342

I couldn't do anything to help him. I called back an hour later, and as I 'd expected, he was dead. At the end of the day, I looked again, and his body was gone. This type of incident must be a daily occurrence out here, but for a newcomer like myself, it's hard to get used to. I met Deepak, who is my interpreter for the rabies/street dog survey. He is a young man from Mayapuri who has been helped by ASHA and is now studying at university, a remarkable feat for a slum boy. He speaks good English, and equipped with the questionnaire and consent forms, we began to stroll around the slum area together, pausing to ask people if they will answer our questions. It was a learning experience for me: much slower and much more difficult. [caption id="attachment_3772" align="aligncenter" width="480"]07-DELHI 361 The slum parallels the railway line, so we walked along it, pausing to interview people[/caption] First, there is the cultural gender issue: Deepak believes that women are illiterate (true here) and ignorant (not true anywhere!) and so he did not feel it was worth talking to them. I tried to dissuade him at first, but there was an obvious discomfort in talking with women, and after emailing Mission Rabies (who designed the questionnaire) about this, I decided that I should only interview men when there is a male interpreter. If I can track down a female interpreter, we will include women. Second, I found it difficult to use an interpreter. How do I know if he is telling me what they tell him, or if he is just giving me the “right answers”? Sometimes the person being interviewed gave a great long answer, and Deepak translated that into two or three words. A great deal of trust is needed and that's difficult when you've just met a new interpreter. I found it tricky at first but as the day progressed, we began to communicate better and his translations began to seem more in line with the person's comments. Third, it takes ages to complete questionnaires like this, and it is tiring. We only did twelve questionnaires on day one: I had hoped to do fifty. What have I learned so far? It's early days, but I'm shocked that most people don't seem to know that dog bites can be fatal, and have never heard of rabies. Yet I also heard from a couple of people that they have known of two or three men who have died of rabies in recent years. I have many more questionnaires to get through and I need to put the data into a proper spreadsheet and carry out formal analysis at the end, but certainly my early impression is that there is a desperate need for community education on street dogs and rabies. My day in the slums was dotted with shocking experiences of life here. Facts from the quesionnaire include the ultra-basic living conditions: up to eight people living in one small room. How pampered we all are in Ireland and the UK: we just don't realise it. [caption id="attachment_3771" align="aligncenter" width="480"]Dogs and children are exposed to continual risk of being hit by trains Dogs and children are exposed to continual risk of being hit by trains[/caption] A train swooshes by at speed, every half hour or so, just a couple of metres from dogs and human children. How many must die every year? An impromptu rubbish tip is topped up every now and again by someone chucking a bag of household garbage on top: when this happens, both humans in rags and street dogs descend on it, picking out anything of remote value. Yet bizarrely, the community workers here are shocked to hear about the high suicide rate in the West – despite the appalling living conditions here, suicide is unheard of. I'm not sure what the message is, but it certainly makes you pause to reflect.  
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