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 Modified from Buffington CAT, Westropp JL, Chew DJ. From FUS to Pandora syndrome: Where are we, how did we get here, and where to now?. J Feline Med Surg. 2014;16(5):385-94.
Buffington and co-workers also identified that cats, as humans, with IC frequently have co-morbidities and
has called this the Pandora Syndrome. He suggests
that the bladder, rather than being the perpetrator of
the LUTS, may be a victim of the systemic process associated with the sensitized central stress response system. Comorbid disorders include behavioural, endocrine, dermatological, respiratory, cardiovascular, and gastrointestinal problems. FIC does not necessarily precede the other conditions. In humans, the effects of chronic in utero stress on the health of the offspring are well documented. It may well be that genetic and similar epigenetic events contribute to the susceptibility of an individual making them at risk should they be exposed to provocative events.
Evaluating the efficacy of therapies for FIC is very difficult because of the waxing-waning nature of the disorder. Stress reduction appears to be a cornerstone for managing cats afflicted with FIC. Addressing environmental needs is essential (not optional) for optimum wellbeing of the cat. Environmental needs include those relating not only to the cat’s physical surroundings (indoors or outdoors; in the home environment or at the veterinary practice) but also those affecting social interaction, including responses to human contact. Cats need to have multiple and separate locations for each resource (food, water, clean litter, toys, stable scratching surfaces, perches and resting areas). The overview of a therapeutic and management approach to a cat with LUTS is shown in Figure 3.
It is essential that cats are able to express their natural behaviours. Cats use olfactory and chemical information to evaluate their surroundings and maximize their sense of security, comfort and feel in control of their surroundings/environment. Depositing pheromones through cheek and paw pad marking as well as urine
is key for a cat’s sense of control. In some situations, when a cat is marking with urine, it may be possible
to get the cat to make a less offensive mark (from a human perspective). Cheek marking wall corners may be encouraged by using Feliway and not washing the cat’s natural oils off walls and furniture. Likewise, providing secure, stable scratching surface placed in the location being urine marked, may result in the cat scratching and marking in that manner rather than spraying. The AAFP and ISFM Feline Environmental Needs Guidelines is an excellent resource freely available from: (jfm.sagepub. com/content/15/3/219.full.pdf+html).
Pheromone Use
FeliwayTM is a synthetic analog of a feline facial pheromone that is thought to increase emotional stability. Its use in the reduction of inappropriate urination needs to be studied further. Studies done to date have shown
a reduction in urine marking of less than three months duration of over 96%. In cats who had been marking for four months or longer, there was a reduction of marking in 91% of cats after 35 days of environmental treatment. A third study showed that while there was a significant reduction in all households in which FeliwayTM was applied, 2/3 of the households still experienced some marking.
The product is sprayed directly on places soiled by
the cat and also any prominent vertical locations in the environment. A daily application is necessary until the cat is noted to exhibit facial rubbing on the site. If the cat does not exhibit facial rubbing, then daily application to the environment should be continued for one month. Plug-in diffusers provide a constant, slow release of pheromone covering an area of 500 to 700 square feet (50-70 m2), but must not be covered, placed behind a door or under furniture.
Diet and Drugs
Feeding a diet that produces dilute urine with a neutral pH seems to help cats have fewer recurrences of FIC
or any type of lower urinary tract disease. Canned food helps to ensure that the urine is dilute, making it less concentrated (hence, less irritating) and reducing the chance that crystals can form. Having plenty of fresh water available in multiple places in a form the individual cat likes will encourage drinking. Some cats prefer drinking from a recirculating water fountain, others prefer wide bowls. Feeding a diet that has omega-3 fatty acids along with anti-oxidants may also provide beneficial anti-inflammatory effects. Finally, being consistent both in time of feeding as well as diet being fed is very important in reducing stress.
Many drugs have been used to try to reduce the reoccurrence of FIC. Amitriptyline may be helpful in some cats if it is given on an ongoing basis. It is an antidepressant and agent that stabilizes mast cells
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