Saturday, May 21, 2011

Solving Inappropriate Elimination in Cats is Hard Work

I hate searching the web for information regarding the care of cats. Most of what I find are reposts from other sites, often repeating the same sometimes lame, sometimes inaccurate information. Many times I can't find what I need (even with Google search) and often I find something interesting after a few days of searching (how do those search engines decide what to show me?)

It was very difficult finding the right information I needed to combat the inappropriate elimination practice of one of our seven cats. Five of the seven were from the same litter. They had no problems learning how to use the litterbox. They all seemed happy and healthy. Then, last year, for whatever reason, the young male at 14 months decided he would have anxiety issues and have trouble using a litter box.  For a few months life seemed hellish. I was constantly surprised by what I would find and where I would find it. I was constantly cleaning. I was constantly doing laundry due to cleaning. I was constantly angry. It was exhausting. And we could not figure out why he would walk by a box and urinate on the floor or walk by a box and urinate on a wall or that he chose the washer or the counter next to it or the utility sink next to that. The places he went and the number of times a day he went seemed endless. We developed a case of phantom urination in our house. Seven cats could be sitting around quietly and then suddenly urine would appear.  Or seven cats would be in one area of the house and suddenly I would smell urine in another area of the house. I spent hours searching down smells. It was exhausting. Over the next six weeks, we took him to the vet, had his urine examined, drew blood for a CBC/chem panel, and got a fancy ultrasound.  It turned out he was very healthy. That meant that something was bothering him.  But still, I could not find enough sound advice online or even in books to help him because they too, repeated the same information-change the brand of litter, use more boxes, give him a psychotropic. We wanted to hire a behaviorist but they are very expensive, often charging a few hundred dollars for an initial office visit and for each subsequent check-up.  Finally, I discovered the free Humane Society behaviorist who gave me some excellent information about which techniques to try to retrain the cat. So, listed below is a compilation of my experience and advice. I hope it serves you well in your endeavors.

First, if your cat is going out of the box, it could be a simple fix or it could be complex.  Our cat is a complex case.  Stop, breath, relax, and realize you will need time and patience to work with your cat to help it.  Know also that it will take time to clean the house initially and that cleaning will be an on-going necessity. The house needs to smell the same throughout to bring a sense of peace to the cat.  From our experience, it seems that once cats begin to go out of a box, the habit can form quickly and be very hard to break and that is because a cat that eliminates on a surface-floor, wall, sink, etc.-has done so because they associated pain/discomfort/lack of appreciation for the litterbox and now finds it was easy/less painful/a joy when they eliminated elsewhere. Therefore, you have a positive association with something other than a litterbox. Once the cat goes there, it will go again in order to experience said joy/relief and you will now have a habit that is forming. Even if you find where the cat goes and clean it, the cat will go there again and again until the habit is broken and the spot is associated with something other than urinating. What it comes down to is changing a cat's association to a litterbox from a negative experience to a positive experience and the places it wants to go with pleasure/joy other than as a tool for eliminating.

From our experience, a cat will go out of the box due to anxiety/fear, inability to get to a litterbox, because litterboxes are dirty (having been used and not scooped out), and because of illness. Three of our cats have urinated out of the litterbox due to illness, either a UTI or due to idiopathic inflammation of the bladder.  One did not always want to sit and so went over the box while in the box. And then there was the little guy who somehow developed anxiety issues.

1) First, you must rule out health issues. The urine must be tested which means a trip to the vet.  Let's assume they have an infection or an inflammation.  For a UTI, our cats have received antibiotics and pain meds (which helped them use the litterbox by helping them not feel pain.) I also gave the cats 3 ccs of water by mouth three times a day for the 14 days of meds.  For idiopathic bladder inflamation, they were given pain meds and I gave them 3 ccs of water three times a day to help keep their bladders flush and working (not sure why it works but it does lead to progress.)  Meanwhile, I let the sick cats use towels, empty boxes, plastic boxes, and the utility sink for a litterbox if they wanted to because of the painful association they had with a regular litterbox. I placed the objects near the litterboxes to encourage them to use the litterboxes or at least to continue to go near where the boxes were located (and not elsewhere in the house.) A cat who is sick will go anywhere especially when a painful bladder means they must eliminate NOW.  As they got better (in a number of hours and days), the ill cats eventually returned to using the litterboxes (either as the issue cleared up or as the pain meds kicked in.)  Once they felt better, the habit/preference to urinate in objects stopped.

2) Secondly, you must have clean litterboxes. Scoop out litterboxes 2-4 times a day-more if you have more than two cats. Wash the boxes weekly with soap and water. Get rid of old and add new litter to any litter that is beginning to collect those tiny lumps of particle waste that you have not been able to scoop out. This usually begins to accumulate after a week. Because we have so many boxes, our cats will usually go one thing in a box and then choose another box for another thing. So, all of the boxes get dirty quickly. Cats hate dirty boxes so keeping them clean and smelling nice is key. We wipe them down each day because dust and old urine and such can get on the edges and sides and if a cat smells it, may not like it and may not use the box.

As for the litter, we have used wheat which some like. We have used Cat Attract and Precious Cat which some like. And we have used Fresh Step which they all like. We cannot tell which boxes are used the most-Fresh Step or Precious Cat. We divide up the boxes between the two litters and alternate boxes with the litters. I know studies say cats do not like scented litters but our cats do not mind the mildly scented Fresh Step. Find what your cat likes best and stick to it. 

3) Let's assume the cat's healthy.  You need to discover if there is anything upsetting the cat.  Is there another pet/cat/dog in the house that could be bullying or upsetting the cat? Or a person or people the cat may not like?  Or work being done in the house or in the neighborhood that is creating noise?  Is it being closed off from you during the day or evening? Is the cat alone during the day? Is the cat bored? Does the cat need more cat time with you, more playtime, more grooming, more attention?  What happened in the days or weeks leading up to the first incident?

a. Once you have discovered a possible cause for what is causing anxiety in your cat, you need to eliminate the cause or lessen its impact on the cat.  The cat needs to remain calm and unthreatened for awhile before it learns how to handle stresses.  If another cat or pet is a bully, you need to separate the two when you are not around. Give them each space and their own food bowls and sleeping areas and their own time with you. If the bully begins to attack or position itself in a threatening position (like hovering over or staring at the other cat) you'll need to remove the bully for a time out. If a person upsets the cat, take the cat out of the room when the person is around or try to get them to interact better with each other. It would depend on what the person does that the cat hates. Try having the person give treats or food to the cat.  If the cat is bored when you are not around, put toys out or more dry food or treats around-on top of and underneath furniture and objects. Use cat nip scattered around in certain areas of the room/floor/house for the cat to find and roll around in and to eat. Is there noise that bothers the cat? If it is possible to move the cat to another part of the house away from the noise, then do so. Shut doors, windows, pull shades in order to block out much of the noise and the sight of the noise (for instance, if workers are working in or outside your home.)  And yes, even cats in the yard might upset your cat and cause him stress. If possible, try to close the shades.  Remember to keep the cat calm and happy as much as possible.

b. Do not reinforce negative reactions to stress by allowing him to remain where stress-causing issues remain.  Do not reinforce his apprehension by petting him when he is upset about something. Try instead to change the subject-offer him a treat, toss a toy, remove him from the stress, brush him.  If you pet him when he is upset, scientists say you are agreeing with him that he should be unhappy because there is a reason to be unhappy. In other words, his reaction to stress and unhappiness is now confirmed. And it is now a habit.  His anxiety will be relieved by inappropriate behavior-namely going out of the box.

4)   Next, determine where is the cat eliminating. Our older male cat kept urinating over the side of the box while sitting in the box. Because he was also acting as a bully to the younger male (and contributing to the younger's anxiety issues) we put him on amitriptyline, a psychotropic. This cured him. He sat in the box, did not spray over the box, and even became less anxious in the house (he used to hide a lot.) For those cats who are eliminating around the house, investigate and try to determine if there is a pattern to places or times the cat goes. Any information you can collect will be helpful in changing the cat's behavior. A cat that is upset with anxiety may spray an object, wall, window, surface as well as use the floor, appliance, sink, counter, blanket, furniture, etc. upon which to eliminate.  When you look around your house, it can be a daunting task trying to find what the cat could be using because it could be anything, anywhere, at anytime. There will seem to be no rhyme or reason. The cat doesn't hate nor love the object it chooses. It doesn't hate you. Something has triggered it to choose a certain spot. Don't try to figure out the why. You might be able to eliminate the object of desire by removing it but you haven't removed the need to use an object.  Let's concentrate or removing the need.

a. Clean, clean, and clean again. If you smell urine in a room, it might be there or it might be blowing in from another area or even the window. Urine tends to change smell as it ages. It goes from smelling like warm, fresh urine to something old, stinky, dirty, maybe even smelling like cat food or maple syrup or decaying trash. Take mild soap (like Dr. Bronners) but not harsh cleansers or vinegar or ammonia based products. Go around the house with bucket of soapy water and a few cloths and on your hands and knees, go from room to room, object to object and sniff around. Silly I know but it is the only way to find where the cat is going and where the urine needs to be removed.  Scrub what can be scrubbed. Wash what needs to be washed. Put waterproof bed liners on the beds if necessary. Toss out what is spoiled and cannot be washed. Wash walls about three feet up, including trim and baseboards and the floors along the same route. Check mirrors and doors and surfaces for drip marks, pooling liquids or yellow stains. Take a clean, damp cloth and wipe down upholstered furniture and drapes/shades to see if you smell anything. Urine is often reactivated when you wipe an area with a damp cloth. If you find it on upholstered furniture, mild soapy water may be able to clean it. Otherwise, have a pro clean it.  Wherever there is urine on a surface or floor, don't clean just what you see or smell but clean the entire area. Urine, like water, travels and it could be in cracks, in between walls and appliances, in the crevices of appliances or windows, in crevices of objects, etc.  Wood surfaces will need to be cleaned again and again until the smell is gone. Linoleum, tile, and glass might clean up with one application.  I have used Dr. Bronner's soap with water; Murphy's Orange Soap spray, Method Grapefruit cleanser, bleach water where possible, Dawn dishwasher detergent on hard to eliminate wood surfaces, and even baking soda-dry and sprinkled on a surface after I cleaned it when the smell would not go away. I left the baking soda on the spot for a week. No one was bothering the spot while the soda was there. It vacuumed up easily. The smell was gone afterwards.

b. Next, if there is a spot that keeps getting hit, clean it and cover it with a hospital pad/bed liner (or adult diaper type of pad/liner.)  Either the smell is still there (for example, on the wall behind an appliance which means you'll need to pull out the appliance and clean it, the hoses/cords, and the wall and floor) or it will dissuade the cat or catch any messes the cat makes.

5) Find what creates a pleasant association for the cat.  I have placed cat nip in certain areas to dissuade the cat and make the area a pleasant place for the cat to hang out instead of going. Food also works. Feed the cat treats or dry food where it wants to eliminate-windows, appliances, counters, floors, etc. We have developed a routine where we give the cat treats in every room. I toss treats in areas where they have eliminated (once spot is cleaned), in corners, on furniture, window sills, counters, etc. wherever a pattern has developed. It seems to work very well but takes time. The cat seems to associate the area with food so that supposedly it will not want to go where it eats. The cat gets time with us. And it gets exercise which seems to burn off energy and anxiety.

6) Develop a routine for the cat for litterbox visits, feeding times, and treat time as discussed in part C. Take the cat and cat treats to the litterboxes three or four times a day. This will eventually work but takes patience and time.  Take the cat to the box, place cat gently in box, and when the cat comes out of box (which will be almost immediately)-whether it has gone or not-give the cat a treat. Begin to associate getting into the box with pleasure-food. Take the cat to the box in the morning when you first wake up, around lunch, late afternoon, evening, and before bedtime-however often you can. Spend 3-5 minutes near the boxes with the cat. Make sure things are calm and that other cats are not bullying or running around and that loud noise or music isn't playing.  Have your treat chasing time as described in part C. Feed the cat at the same times each day, even weekends. Set aside playtimes maybe twice a day. Routines will help establish when the cat gets fed and when it needs to eliminate.

When the cat developed an aversion to litterboxes, it took weeks of sticking to a routine, of using treats with boxes, treats around the house before he began to constantly go in a litterbox. But he still seemed averse to using boxes upstairs even though they had the same litter as those downstairs. We tried wheat litter and he began using it immediately. Soon, he began using the other clay boxes upstairs and we eventually replaced the wheat with the clay once he began only using clay upstairs.

Feliway, the pheromone plug-ins and spray do seem to calm our cats but I can't say that it alone would work to solve out of the box issues. When we began using the plug-ins and spray, it did calm the one cat but it didn't solve any of his issues. Furthermore, they are expensive. To work effectively, you need to plug them in all around the house and at $25.00 per plug-in per month, that becomes costly. The spray works best when used in areas where the cat once sprayed or around areas it visits/sleeps often and not when sprayed all around the house like one would air freshener. We've actually had the cat urinate where we put Feliway because I think he thought that another cat was in the house.  You don't have to spray it a lot to get it on an area.  A gentle spritz will suffice. But never use it on the cat. It's not meant to be put on them and would sicken the cat.  Feliway can be ordered for less than $25 from various on-line stores.
Finally, after routines, treat training, toys, grooming, spending time with him, and eliminating all fear inducing, anxiety causing, stress related causes, the cat in question was doing very well but was still having issues. His out of the box occurrences had greatly decreased and he was beginning to go to the boxes without our prompting. He had gone from a high of 68 out of the box issues in one month to (after three months) 30 or so.  But that was still too high a number. We decided to try medication.  It may seem odd that a cat may need medication for anxiety but it is not as rare as you might think.  And unless there are adverse side effects that a particular cat experiences, there are few general side effects of which to be wary. At first we used amitriptyline which helped a bit but caused issues with his bladder by causing urine retention. He was not able to go but almost once a day. It also has a doping effect which was severe for him because it made him drag and sleep a lot.  Meanwhile, our older male cat was on the same med at a higher dosage with no ill side effects or bladder issues.  After a couple months of changing dosage to no avail, we switched him to Prozac. This too has a urine retention side effect not seen in most cats which we still saw in him. We surmised that his bladder must be sensitive to all influences.  We then put him on liquid-compounded-Prozac. We give him .11 ml (the original dose was .125 which he could not tolerate.)  We maintain routines, treats, stress relievers, and the medication and it has solved 95% of his issues.  We are working with our HCM cat now with behavioral training and seeing progress. We are hesitant to place her on Prozac but it is a viable option for HCM patients.  I still constantly clean, constantly do laundry but it is no longer a nightmare.

I have also learned to lean on God to give me the information and tools I need, the love and patience I need, and to take over the issues with all of the cats. There is harmony in our house even if we still have an issue here and there. Well, there is harmony as long as they are fed.

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