It’s all in the name – should we rename FIC and CDS?

First impressions count – the first time we tell an owner the name of the condition their pet has developed establishes their understanding of their pet’s problem.

For example:

“Ms Jones, we have found that Milo has feline idiopathic cystitis [FIC] and we understand that stress plays a major role…”

 What does the owner hear?

“Ms Jones, we have found that Milo has bla bla bla cystitis, and we understand that stress plays a major role…”

What does Ms Jones now understand? Since most cases of cystitis in people are bacterial and treated using antibiotics, she presumes her cat needs them, too. She expects to be given them and will feel aggrieved if you do not supply any. It does not make any difference that you just told her that “stress plays a major role…” (Figure 1).

She heard the word “cystitis” before she heard the word “stress”, so she was already thinking about antibiotics before you got round to mentioning stress.

In addition, you did not say that stress caused the condition, so you have given her a good reason to ignore any role it might play – after all, she can see her cat is clearly not stressed.

She knows him best – that poor, fat, black and white, male cat that sits on your consultation table, frozen with fear – and she has just told you that of her four cats, he is a “very polite”, timid cat that lets the other cats sleep in all of the best sun spots in the house, even getting off to give them his place if they come close.

Sadly, many owners of cats with FIC are slow to believe stress plays a major role in their cat’s illness. Moreover, few vets have the time to explain the importance of stress in FIC to a reluctant owner.

But we do know stress plays a major role in causing and triggering this condition^1,2. FIC is very similar to interstitial cystitis in people³, which can be treated using mindfulness, which is just one of the many pillars of evidence that shows stress plays a significant role in its aetiopathogenesis⁴.

So, why is this of interest to us? Well, given all of the evidence that shows stress plays a much greater role than any other possible aetiopathology, what if we rename FIC as “stress cystitis”? This way, when we return Milo to his owner, she will hear:

“Ms Jones, we have found that Milo has stress cystitis.”

Hence, she will hear “stress” before “cystitis”, which places the emphasis on needing to identify and reduce the stress Milo is feeling, and the need for antibiotics has been avoided.

Why rename cognitive dysfunction syndrome?

What will Mr Smith hear when you hand back his beloved old kitty and say:

“Mr Smith, we think Jenny has cognitive dysfunction syndrome [CDS]”?

He will hear:

“Mr Smith, we think that Jenny has bla bla bla syndrome” or “Mr Smith, we think Jenny has bla bla bla bla.”

He will feel confused and anxious, and we will not have helped him at all.

All owners are anxious when they bring their beloved pets to see us, and the owners of elderly cats are perhaps the most anxious. In addition to the stress of actually catching the cat and getting it into its basket, and the yowling in the car, they are very worried that we will recommend their cat should be euthanised.

We know 36% of owners of cats aged 7 to 10 years old report their cats had developed age-related behavioural problems⁵, with this increasing to 50% of cats of 15 years of age or older⁶, and up to 88% of cats aged between 16 and 19 years old⁵. The altered behaviours can be listed under the acronym of VISHDAAL (Panel 1).

This acronym places the “V” for increased vocalisation at the start as it is the most commonly altered behaviour in cats with CDS, occurring in approximately 60% of them, with cats crying equally in the day, night or both^6,7.

Sadly, owners rarely volunteer that their cat is waking them up at night, crying through the day, house soiling or confused. They are embarrassed and worry we will think they are poor owners because they cannot cope and that we will euthanise their cat.

However, we know that despite these problems, owners of elderly cats don’t want just any cat – they want this cat^6,8. It therefore behoves us as good vets to be sensitive to our clients’ fears and help them understand what is happening to their beloved pet.

CDS has many similarities to Alzheimer’s syndrome in people⁵, which is one of a number of conditions that result in dementia in people. To add clarity and reduce confusion, it would help owners to understand what is wrong with their cat if we renamed CDS, and call it “feline dementia” (Figure 2).

This way Mr Smith will understand what is wrong with Jenny when he gets her back, not needing to overcome his embarrassment to ask. He may have had an elderly relative with Alzheimer’s syndrome and dementia at some time, so he is likely to have a reasonable idea of what Jenny is suffering from, empathise and understand how she is likely to progress.

However, this does not mean we do not need to supply easy to understand information sheets, but it does help to improve owners’ overall understanding, meaning they are more likely to follow our instructions on how best to manage their pets’ care.

We are sure many of you are updating your discharge letters, owner information sheets, clinic posters and so on, changing them to plain English and removing complex scientific wording to help owners to understand them. However, as vets, we often forget we are in the top 1% to 2% of intelligence within the population.

While we are simplifying our discharge letters and owner information sheets, we believe we should also consider renaming some conditions. For this reason, we think we should rename FIC as “stress cystitis”, and CDS “feline dementia”.