The stats are in, and the cat rules. No longer are dogs the most popular American household pet, and Forum approached board-certified feline practitioners who own cat-only hospitals to pass along their tips on what makes their practices run purr-fectly.

With the new feline and canine vaccine guidelines, the economics of veterinary practices may change dramatically, says William R. Folger, DVM, DABVP (Feline Medicine), who has owned Memorial Cat Hospital in Houston, Texas, since 1993. "All of us want to remain competitive, but we need to realize that certain profit centers are going to disappear," he explains, "and vaccination represents one of them."

But that is only one profit center that may soon erode practitioners' profit margin, he adds. "General surgeries, like spays and neuters, also are going to disappear because of the abundance of low-cost services and new sterilization guidelines associated with shelter pet adoption. Pharmacy profit centers likewise are going to dwindle because of the multiple online pharmacies."

Finding new, viable profit centers will be essential for practitioners to adapt to changing trends in veterinary medicine.

But taking advantage of the growing popularity of cats as pets may be tricky for small animal practitioners for one reason: dogs.

The great advantage of a cat-only clinic is that there are no dogs, most of our experts say , indicating that many cat owners prefer taking their cat to a dog-free environment.

"About 20% of my clients select us because we are a feline-only practice," Folger says, "and do not have the adverse atmosphere that a dog practice has — the smell, the barking, the noise. Cats here can enjoy a peaceful environment, which goes a long way in helping us evaluate the health of each cat."

Arnold Plotnick, DVM, DABVP (Feline Medicine), who owns Manhattan Cat Specialists, a feline-exclusive hospital in the Upper West Side of New York, agrees that the stress associated with visits to the general practitioner can be a deterrent: "My clients tell me they selected my practice because their cat does not see, smell or hear any dogs. In a multi-pet hospital, by the time a cat makes it into the exam room, it may be so frazzled that the examination is near impossible."

"If cats live in a household without dogs, introduction to dogs is a terrifying event," says Gary D. Norsworthy, DVM, DABVP (Feline Medicine), a member of the Veterinary Forum Editorial Board. "Cats will show their worst behavior if they encounter what they consider to be a threatening situation," which can prevent owners from bringing cats to the clinic for the health care they need.

Not so fast, says Susan Little, DVM, DABVP (Feline Medicine). "I frankly believe that the dog factor is overestimated. Feline practitioners tend to place too much emphasis on the interaction between cats and dogs as if the visit will magically be stress-free if no dogs are around."

That simply is not the case, she adds. "Some cats do not want to visit the veterinarian regardless of whether they will encounter, hear or smell dogs. We tend to forget that cats also don't like other cats."

Little, who has practiced feline medicine for more than 17 years as owner of Bytown and Merivale Cat Hospitals in Ottawa, Canada, explains that "many of the reasons a cat becomes stressful are because of what happens before it even reaches my clinic. It can be stressful for cats to get into a carrier, leave the safety net of their home and travel in a car. So whether there are dogs in the clinic at the end of the trip is not the only stressful factor that needs to be eliminated."

To relieve the stress of a visit to the veterinary office, Little offers some handy suggestions that cat owners can follow, such as recommending that owners make the carrier available to the cat a couple of days before the visit to become accustomed to it (see Before Leaving the House — Helpful Hints for Owners).

"However," says Little, who also is president of the Winn Feline Foundation (www.winnfelinehealth.org), "a lot of feline stress and misbehavior could be avoided if practitioners sponsored kitten kindergarten classes." The Winn Feline Foundation recently held a Kitten Kindergarten Symposium featuring animal behavior consultant Steve Dale (www.stevedalepetworld.com). "The popularity of these timely classes is growing because they are designed to help kittens become acclimated to strange objects, such as carriers; scary events, such as a trip in the car or visit to the veterinarian; and even to strangers." Also covered are basic dietary, feeding, medicating and grooming tips.

"This experience not only can help your feline profit center grow," Little concludes, "it can reinforce the need for owners to present their cats at scheduled wellness exams."

Improving your image

So how can small animal practitioners improve their credibility with cat owners? Norsworthy, who has more than 30 years of practice experience, started Alamo Feline Health Center in San Antonio, Texas, about 7 years ago. Before that, he was affiliated with a small animal practice, so he is quite familiar with the pitfalls associated with treating both cats and dogs. "Small animal practitioners need to get the message across that cats have an equal status to dogs."

"I believe a lot of cat owners feel that some practices favor dogs over cats and say that it is obvious in the way cats are treated as second-class citizens," offers Plotnick, who also is a member of the Forum Editorial Board. "My staff and I are crazy about cats, so small animal practitioners should avoid treating a feline profit center as a profitable business goal only. Cat owners can tell how you feel about their cat," he adds.

Norsworthy concurs: "The sad truth is that probably more than 50% of small animal veterinarians love dogs and tolerate cats, and cats and their owners can sense that. My advice is to be conscious about the image you present in the waiting and exam rooms and through staff interactions. Give the message that you really like cats."

One way to beef up your image is to have a technician who is well-suited to assist you, says Folger. "You need a technician who is perfectly comfortable handling and restraining cats for examinations and diagnostic procedures."

"If you own a multi-doctor facility and one veterinarian strongly prefers working with dogs," Norsworthy suggests, "you don't want to assign cat cases to that person. On the other hand, by identifying which doctors truly enjoy working with cats, you will be taking advantage of the assets at your disposal."

Carefully selecting employees who are cat-friendly is difficult, adds Folger, because "you have to expose them to a day's worth of physical examinations with cats to properly evaluate whether the person is a suitable candidate."

And that is precisely what Norsworthy does: "After the initial screening process, we have a working interview and pay the candidate even if we do not hire him or her. But we also recognize that bonding with cats can be a growing event. The individual will either get to the point of feeling really comfortable around cats or decide to leave the position."

Little adds that it is helpful if the potential hire is a cat owner. "If your staff members live with a cat on a daily basis, they are better able to handle the ordinary questions and concerns that cat owners have."

Creating a cat-friendly environment

All our experts agree: Small animal practices need separate waiting rooms — one designated for cats and one for all other pets.

When he visited a colleague at a small animal practice in Austin, Texas, Norsworthy says, "I found a dog waiting room and a cat waiting room. The dog waiting room is utilitarian — you could drive a tank through it and not hurt anything. The cat waiting room is like your living room — nice furniture, nice chairs, pictures on the wall, lamps on end tables."

And, he adds, there was no wear and tear in the cat waiting room because owners bring their cats in carriers. "There are no dogs jumping on furniture and scratching tables or urinating on the floor. The cat owners' first impression is, 'Wow, this experience is going to be different!'" When Norsworthy returned to San Antonio, he made the waiting room in his new clinic a unique experience for cat owners, complete with reproductions of antiques.

Plotnick also recommends designating one exam room solely to cats, and the other experts concur: "Small animal practitioners need to rethink the entire design of the clinic," offers Little, "and consider how the cat is going to perceive the visit — where the cat is going to go, what it is going to see, smell and hear and how you can make the cat's experience the best situation possible."

"Separating the physical examination room from the rest of the clinic helps," Folger says. "Our exam rooms are carpeted and quiet inside. We don't use stainless- steel exam tables — we have Formica custom-built examination tables." The exam room also features two comfortable chairs so owners can sit and hold their cat while waiting for the doctor."

Little recommends moving the cats quickly from the waiting area — even a feline-only waiting area — into the exam room. "We want the cat to become familiar with the exam room surroundings while in the safe haven of its carrier. We ask owners not to remove the cat from the carrier immediately."

When Little enters the exam room, she doesn't make an effort to remove the cat. "I will open the carrier door but will not attempt to remove the cat. Instead, I use the initial 5 or 10 minutes to talk with the owner." During that time, Little says, most cats will venture out on their own because they are not being threatened. She adds that loud music and boisterous voices can agitate the cat. "So it is important that practitioners consider everything that will happen to the cat up to the point of the actual examination and plan accordingly."

It's all in the presentation, says Norsworthy. "My six exam rooms are not numbered but instead have a cat theme, such as the Garfield room, Cat in the Hat room, and Sylvester room," which sends the message that cats are really liked in the practice. "I explain to externs that cat owners want to know first, 'Do you like cats?' and second, 'Do you like my cat?' and we answer the first as soon as the owner walks through the clinic door. We answer the second question by how we interact with the cat."

Small animal practitioners need to attend to detail in the cat-only exam room and never allow a dog into the room to deposit its smell, Folger says. "We don't allow dogs inside our clinic to avoid smell contamination. So a well-designed feline-only space in a mixed-animal practice needs to project a feline-friendly environment.

"Lots of smells other than those of dogs can be offensive to cats," he adds. "If strong disinfectants, such as povidone"iodine, were used with the previous patient, the vet's coat should be changed, along with the traditional hand-washing. Cigarette smoke on the fingers of a lab technician can offend cats, too. What may seem to be a trivial consideration when dealing with a dog can interfere with the examination and evaluation of a cat."

"Always project a calm image," Plotnick says, "that relieves the cat's anxiety about being in a strange or uncomfortable environment. Placing incense and scented oil in waiting and examination areas as well as piping in quiet background music can help put the cat at ease."

After practitioners have created a cat-friendly atmosphere, the examination itself can become tricky.

"A lot of cats feel more secure if they are covered with a towel," says Little, "because they feel as if they are hiding," but she cautions against using anything except gentle restraint. "Cats are predators, but they also are small enough that other animals prey on them. So cats have a mindset that they can be subjected to harm at any time."

One rule small animal practitioners need to follow is, "Do not fight with cats," Little emphasizes. "On rare occasions, we might use an Elizabethan collar to complete a short procedure, but we never use gloves."

Escalating restraint, the experts warn, can escalate the cat's fear and anxiety level quickly. If that occurs, they recommend immediate sedation so that the cat's fight instinct is not activated, which will make it aggressive.

"It is a predatory instinct for them," Little explains. "Their natural behavioral instinct is why a lot of cats are fearful outside their normal environment."

And that same predatory instinct is the reason cats hide medical conditions so well, the experts say.

It becomes a catch-22 because cats really need to visit the clinic twice a year, not once a year, for the veterinarian to ask owners the questions that can detect hidden conditions. But because cats hide medical conditions, owners don't recognize the need to see their veterinarian that often. "Helping owners recognize their cat's veterinary needs is really about client care and communication," Little says.

"You need to develop a good rapport with cat owners," Little continues, "and to listen carefully to everything the owner says because cats hide their signs so well, the owner may not even realize there is a problem. Take time with the owner and take time with the cat — don't rush through the examination."

Little explains that during wellness examinations, cat owners may pass along information that seems frivolous, such as how cute their 10-year-old cat is to watch now that he has started howling each night in the dining room. "Howling," Little emphasizes, "is a medical sign that the cat may have high blood pressure. It is inappropriate vocalization in a senior cat, and howling at night in particular is commonly associated with high blood pressure."

In another scenario, asking normal questions about a cat's litter box habits may prompt an owner to say, "My cat's kidneys work very well." However, that typically means the cat is producing excessive urine in the litter box, Little adds.

A recent health campaign for cats, partly sponsored by the American Association of Feline Practitioners (AAFP), was initiated by Fort Dodge Animal Health to help make owners aware that cats should be seen by the veterinarian twice a year. The campaign was based on 10 early warning signs of illness in cats (see Subtle Signs of Sickness) that owners typically ignore as being trivial, such as changes in litter box habits or attitude or in the degree of playfulness. "These are behaviors that owners might not equate with states of illness," Plotnick says.

"I recommend semiannual visits," he adds, "especially for middle-aged and senior cats. In cats between 3 and 7 years of age, as a minimum diagnostic procedure, I conduct some baseline blood work. But I also ask key questions that can identify hidden disease." Has the cat been eating and drinking normally? Has there been any coughing or sneezing? Is the cat vomiting or having diarrhea? Plotnick also checks on the vaccination status, especially for FeLV and FIV.

"During the examination process, if anything makes me suspicious of a metabolic illness, I will suggest evaluating the liver and kidney and testing red and white cells, electrolytes and blood sugar," he continues, since common feline conditions include diabetes, renal disease and hyperthyroidism.

"We have a well-established senior wellness protocol," Folger says, "and I always have about 15 follow-up senior profiles each day. If mixed-pet practitioners seriously want to develop their cat profit center, they need to institute — over a 2- to 3-year period — a comprehensive senior wellness program. Once you identify a disease state, such as chronic renal disease or hyperthyroidism, you will develop a strong relationship with clients because you are going to see their pet four to six times a year."

In addition, Folger recommends that practitioners become well-versed in the etiology of lower urinary tract disorders. "Classically, in cats younger than 10 years of age, only 1% to 3% is caused by infections, while 65% is caused by chronic interstitial cystitis. This one disorder constitutes about 10% of my caseload," Folger says.

In addition to obtaining a minimum database, Nors-worthy routinely performs an electrocardiogram (ECG) on all cats. He advocates taking veterinary medicine one step further in providing the best possible health care, and he learned the value of doing that by conducting routine ECGs. "It turns out," says Norsworthy, "that the cats had a lot of heart disease I was missing. So my reason for doing ECGs shifted from an advocacy position to one of looking for early heart disease in cats. Between the stethoscope and ECG, I am looking for specific flags that indicate the cat needs an ultrasound exam."

All of the experts agree that dental evaluation is a routine part of the overall physical examination, especially since cats have an oral disease that dogs don't have — feline odontoclastic resorptive lesions, or FORLs — cavities that start at the gum line and quickly expose the sensitive areas of a tooth.

"FORLs can be very painful," Norsworthy says. "I find a cat with a FORL almost every day, and the lesion is easy to identify on examination. The gum grows over the cavity at the gum line, so the practitioner will see a little red piece of tissue covering the neck of the tooth. That is the first red flag," Norsworthy explains, "and then if the practitioner touches the area with a fingernail and the cat's lower jaw starts to quiver, that is diagnostic of a FORL." The only cure is tooth extraction.

One controversial procedure routinely done is declawing. Folger, who was chairman of the subcommittee on declawing for the Animal Welfare Committee of the American Veterinary Medical Association and on the declaw committee for the AAFP says most feline practitioners are ambivalent about the procedure. "In a perfect world, no declaw procedure would be done on cats. But it is not a perfect world, so 95% of the declaw procedures in my practice are done because the owners wish to avoid property damage."

In his practice, about half the patients are declawed, and Folger says the procedure is not encouraged or discouraged. "We do not bring it up in our conversations with new kitten owners or any owners because we want the client to approach the subject, not us."

Both Plotnick and Norsworthy also are declaw-neutral, but Plotnick adds that he resents people who exaggerate and raise ridiculous propaganda by blaming declawing for all of a cat's behavioral problems, and Norsworthy agrees: "Problems with declawing have to do with the technique. And we need to remember that a lot of cats will not be kept in the home unless they are declawed." Norsworthy believes in declaw laser surgery because it offers superior pain control, adding that "two-thirds of the cats I see are indoor-only. I don't advocate declawing cats that go outdoors."

Even if a veterinarian isn't starting a feline-only practice, making a few changes in the attitude of staff, the logistics of the office and the way feline patients are cared for can help increase client compliance and improve the practice's bottom line, Forum experts say.