Q&A: Preventing the Preventable

What does modern feline preventive care look like? Ken Lambrecht, DVM, discusses early detection, weight management, stress reduction and the technologies poised to change how veterinarians monitor cats.

When you think about preventive care for cats today, what does a truly comprehensive preventive health program look like? Has that definition changed during your career?

Dr. Ken Lambrecht: We used to think of preventive care as vaccinations and flea, tick, heartworm and intestinal parasite prevention. Today, it is so much more. We now have wellness and genetic screening that can detect so many new health risks, incredible leaps in cardiomyopathy detection, biological age tests and data analysis testing on the way. There has been an incredible increase in prescription diets for almost every disease, as well as microbiome support. Vaccines have improved dramatically in effectiveness, with fewer side effects, along with parasiticides that even prevent New World screwworm, as well as every other major parasite, with monthly dosing.

I have always focused on “preventing the preventable,” starting with the most common diseases. Preventive care, as outlined above, is at the base of the pyramid, followed by dentistry, obesity and its comorbidities, including diabetes and osteoarthritis, as well as heart, kidney and other diseases.

We need to start with kittens! We need to make sure they are completely vaccinated, out to 6 months now per AAHA/FelineVMA guidelines. We also need to make sure their home pillars of care are met so they are stress-free, as so many diseases in cats can be linked to stress. With 60% of cats now identified as being overweight, we need to monitor their weight regularly and carefully throughout their lives.

Today, we also face an accessibility challenge, so a comprehensive program cannot always be fully afforded or implemented. The basics of vaccination and parasite control will always apply, but time spent educating clients about nutrition, behavior and other vital preventive issues can be done before, during and after the appointment using all of the amazing emerging client communication platforms.

Cats are masters at hiding illness. What subtle changes should veterinarians encourage owners to watch for before a problem becomes advanced?

Dr. Lambrecht: Simple things like where the cat is sleeping, how much they are playing and their mobility will always be vital elements of their quality of life. These need to be monitored and, ideally, trended.

Any behavior changes are important. The issue is that many of our cat owners are new to cat ownership and don’t know what to look for. That, again, is where education from us and our trusted corporate partners is vital.

Their environment is also important. How many litter boxes per cat? How many cat trees? How should feeding stations be set up? And so much more is part of living with cats and providing what they need based on their unique biological status as felines.

To fill the gap, wearables and facial cues will help. There has been an almost endless string of wearables for cats, and now a few have matured enough that they could show early changes. Grimace scores, developed in Montreal and expanded by Sylvester, have shown that they can alert clients using discomfort scores, detect disease early and even drive veterinary visits.

Feeding frequency and behaviors are becoming easier to track with emerging smart feeders, and litter box monitors like Petivity are making elimination behaviors easier to detect.

What are the biggest preventive health opportunities you believe veterinary teams are still missing when caring for feline patients?

Dr. Lambrecht: As mentioned, I truly feel veterinarians need to be the leaders in prevention education for clients. Influencers and companies with a profit motive bombard pet parents. Veterinary teams must be the source of truth for what to watch for and how to measure discomfort, weight, elimination habits, amount eaten and activity.
The exam room is just the beginning. We need to be in many more places and work with feline organizations like FelineVMA, EveryCat, the CATalyst Council and Fear Free to keep the education going. Speaking at cat shows, writing blogs and using social media are all our responsibility so the veterinary team’s voice is heard.

Keeping up on home health devices and platforms is also important. There is a literal explosion of cat feeders right now, with no testing to make sure they are cat-friendly and deliver the correct amount of food. Helping clients decide on home health devices, how to feed their cats and what to feed their cats are huge opportunities, given the long-term risks of obesity and its many comorbidities.

Many cats still don’t see a veterinarian. What are the biggest barriers, and how can practices make preventive visits less stressful for both cats and their owners?

Dr. Lambrecht: Hands down, the biggest barrier, as defined by Jon Ayers of the CATalyst Council, is cost. Many of today’s new cat owners do not have financial reserves, so I think practices and industry need to develop cost-effective wellness and subscription plans to allow care to be provided to more cats and kittens.

Those visits are the ideal time to educate clients and get them started on a lifetime of good preventive care. Discounting kitten visits and first-time cat visits should also be considered to help build trust and keep veterinarians at the center of care.

Keeping visits less stressful is about education. The teams at FelineVMA, which create Cat Friendly Guidelines, and the feline Fear Free programs both have certificates that I feel should be mandatory for anyone seeing cats. There are just too many ways a visit can be mishandled, causing the cat or pet parent to never want to return to any veterinary clinic.

You have a particular interest in chronic feline disease management. Which diseases benefit the most from earlier detection through preventive care?

Dr. Lambrecht: Obesity tops my list, as more than 60% of cats are affected. Its comorbidities, including osteoarthritis and diabetes, could be prevented, too.

In older cats, CKD, hyperthyroidism, lymphoma, IBD and others can benefit from early detection. Most, if not all, of these can be detected by inadvertent weight loss, which is why I have been so preoccupied with getting cats’ weights in any way possible throughout my career. Following those weight trends is vital to early detection.

Most cats gain weight between 6 and 10 years of age, but I have seen obesity as early as 2 years of age that could have been prevented with simple measurement of food and routine weighing of the cat.

We need to focus more on nutrition, use of non-branded calculators, help owners make good food choices for their pets and make it easy for them to come in for reassessments. For cats that travel well, we can provide in-person reassessments. For those that don’t, we can provide telemonitoring and home health device advice.

After more than four decades in practice, what advances in feline preventive medicine have had the greatest impact on improving quality of life?

Dr. Lambrecht: Along with the strides we’ve made in nutrition, vaccination and monthly parasite prevention, I think we have made the greatest strides in how we respect cats as a unique species, especially compared with dogs, particularly in the area of behavior.

The wonderful advances we have made in focusing on feeding frequency, active play with our cats, the use of pheromones and studies of their quality of life are becoming more frequent and supported by industry. Behavior is, of course, the softer side of veterinary practice, but it can really make the difference in allowing us to provide pet parents with a lifetime of good care for their cats.

Along with that, the incredible strides we have made in both in-house and reference laboratory wellness and specific testing, such as the ProBNP test and others that allow us to be proactive in detecting disease, have been game-changing as well.

Where do you think feline preventive care will change the most over the next decade?

Dr. Lambrecht: I think we are going to see continued sophistication of devices like Petivity and Litter-Robot that will monitor fecal and urinary output and frequency. With the plethora of webcams now available on cat feeders and litter boxes, we will have the ability to monitor fecal scores, verify feeding and litter box activity, making early diagnosis much easier.

Getting accurate weights on cats has always been a missing link, but these devices are making progress on that as well. Feeding station education and how to manage feeding in multiple-cat households are areas where I think there is almost limitless potential.

In my opinion, real advances will be made when we can get that data all in one place easily, using AI agents and good software to show trends and alerts. There is a real case for sharing the data, identifying where it came from and making sure it is valid so it can be displayed side by side with the lab work, weights and other data we gather at the clinic. That could help close the gap on what happens between visits and allow us to be truly proactive.

I predict we will accomplish things that won’t even happen in human medicine, given the uniqueness of pet care.

I also think we are going to see valuable research occur in the home. Given the accuracy improvements of home devices and the lack of stress in the home environment, I think we are going to see products leap forward in effectiveness and reduce the time it takes to bring them to market.

Many love to call this surge of innovation and attention to the feline species the “year of the cat,” but I personally prefer the “decade of the cat” — or longer!

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