Pandora syndrome: Rethinking our approach to idiopathic cystitis in cats - Veterinary Medicine
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Pandora syndrome: Rethinking our approach to idiopathic cystitis in cats
Cats with idiopathic cystitis often have multisystemic comorbidities, so look outside the urinary tract—as well as in the cat's environment—for diagnostic and therapeutic answers.



Environmental enrichment is the first line of therapy to reduce the risk of recurrence of whatever clinical signs are present.10-12 Environmental enrichment for indoor-housed cats means providing all necessary resources, refining interactions with owners, achieving a tolerable intensity of conflict, and thoughtfully instituting changes.13,14 The broad categories of food, water, litter boxes, space, play, conflict management, and pheromones should all be considered based on their influence on the health and welfare of indoor-housed cats.

Household Resources Survey
Have clients fill out the household resources survey (click here to download the survey) to help pinpoint areas to focus on. To use this survey, review answers on each of the basic needs (space, food and water, litter boxes, social contact, and body care and activity) with clients after they have completed the questionnaire. First, thank the client for completing the survey. Next, identify any rows marked "DK" and clarify the intended meaning for the client to get an answer. Then praise the owner for all "Yes" answers, and explore the importance of any "No" answers. The objective is never to blame the client for any deficiencies but to identify areas of improvement in the basic needs systems that the client thinks are changeable. The priority box can be used in conversation with the client to decide the order in which to address improvement in areas where "No" responses were identified.

Because of the dearth of controlled trials, it is not possible to prioritize the importance of any of these suggestions or to predict which would be the most appropriate in a particular situation. Appropriately designed epidemiologic studies might be able to identify particularly important factors, after which intervention trials could be conducted to determine their efficacy in circumstances in which owners successfully implemented the suggested changes.


Cats prefer to eat individually in quiet locations where they will not be threatened or startled by other animals, sudden movement, or an air duct or appliance that may begin operation unexpectedly while the cat is eating. Although canned food may be preferable for some cats because of the increased water content or a more natural mouth feel, some cats prefer dry foods. If a diet change is appropriate, offering the new diet in a separate, adjacent container rather than removing the usual food and replacing it with the new food permits the cat to express its preference. Specific ingredients or nutrients in food have been found to be of minor significance to patient outcome when an enriched environment is provided.10-12

Natural cat feeding behavior also includes predatory activities, such as stalking and pouncing. If a cat is interested, an owner can simulate these feeding situations by hiding small amounts of food around the house or putting dry food into a container from which the cat has to extract individual pieces or move to release the food pieces. Some cats have specific prey preferences. For example, some cats prefer to catch birds, while others may prefer to chase mice or bugs. Identifying a cat's prey preference allows the owner to buy or make toys that the cat will be more likely to play with.


Cats also seem to have preferences regarding drinking water. Water-related factors to consider include the freshness, taste, movement (water fountains, dripping faucets, aquarium pump-bubbled air into a bowl), and shape of the container (some cats resent having their vibrissae touch the sides of a container when drinking). As with diet, changes in water-related factors should be offered in such a way that permits the cat to express its preference. Additionally, food and water bowls should be cleaned regularly unless individual preference suggests otherwise.


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