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MODULE 8 - SENIOR PETS

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Andy Krywawych

on 5 December 2015

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Transcript of MODULE 8 - SENIOR PETS

MODULE 8 -SENIOR PETS
SENIOR CATS AND DOGS
Improved medicine, preventative healthcare and nutrition allow pets to live longer healthier lives
Cats live on average 15 years
Dogs live on average 13 years (depend on breed and size)
Some dogs and cats can live up to 20 years
All animals age and their bodies are affected in many different ways
Older bodies become less functional and active than when younger and external signs may show
Early detection can help minimise problems and slow them down
SENIOR AND GERIATRIC
MATURE (MIDDLE AGED)
- begins around 6-7 years
SENIOR
- begins around 10 years
GERIATRIC
- begins around 12 years in dogs and 15 in cats
Aging in large breed dogs tend to occur 1-2 years earlier
Helps to determine the varying disease risks of the different groups
SENIOR PET CLINICS/CHECK UPS
Show owners how to brush and care for teeth
Advice on feeding correct diet and nutritional advice for clinical disease
Monitoring weight and body condition
Behavioural advice
Health check examining ears, eyes, nails, teeth, genitals, skin and coat
Clinical exam may include checking blood pressure, blood and urine
AGING
Aging is not a disease but manifestation of body's diminished repair response
Aging is often associated with a variety of diseases
Aging process depends on various factors including genetics, breed and health problems
AGING CHANGES
Less able to fight infections (altered immune system)
Obesity (decreased metabolic rate)
Loss of muscle mass
Arthritis and loss of flexibility
Dental problems
Deterioration of skin and coat (more fragile, wrinkling, altered pigmentation)
More frequent intestinal problems
Decreased nerve cells and function
Thickening of eye lens
SENIOR PET CARE
COMMON DISEASES IN OLDER CATS
Chronic renal failure
Hyperthyroidism
Diabetes mellitus
Hypertension
Neoplasia
Periodontal disease
Arthritis
FIV
BLOOD PARASITE - BABESIA
Babesia gibsoni
HAC SCREENING
LDSST: High cortisol at 8 hours = HAC
LDSST: If cortisol low at 4 hours and then high at 8 hours = PDH
LDSST: Low cortisol at 4 and 8 hours = normal
ACTH STIM: Post ACTH causes high increase in cortisol = HAC
COGNITIVE DYSFUNCTION SIGNS
BEHAVIOURAL CHANGES:
MEASURING BLOOD PRESSURE
BLOOD INTERPRETATION
ALT - ALANINE TRANSAMINASE
CATARACTS
Lens in eye focuses an image to retina
Healthy lens is clear and made up of tissue fibres
NUCLEAR SCLEROSIS
- cloudy eye as lens becomes more dense (compact and compression of existing fibres) with new lens fibres. Lens is still clear and NOT a cataract
CATARACT
- abnormal lens in which an opacity (due to pigmentation and lens fibre disruption) prevents light reaching the retina leading to blindness
Cataracts can be genetic or as a result of age, trauma, ocular inflammation, retinal degeneration or diabetes mellitus
More common in dogs than cats
WBC ANALYSIS
Machines good for absolute WBC counts but not percentages
Count first 100 white cells
Keep log of number of segmented neutrophils, band neutrophils, lymphocytes, monocytes, eosinophils and basophils (relative count)
Multiply numbers by total white cell count (e.g. 12000) to get absolute count cells
Normal values cats: mature neutrophils (35-75%) bands (0-3%), eosinophils (2-12%), monocytes (1-4%), lymphs (20-55%), basophils (rare)
Normal values dogs: mature neuts (60-70%), bands (0-3%), eos (2-10%), monocytes (3-10%), lymphs (12-30%), baso (rare)
BLOOD INTERPRETATION
SODIUM
CHEST RADIOGRAPHS
COGNITIVE DYSFUNCTION
Similar to Alzheimers disease (dementia) in humans
Neurological degenerative disorder leading to brain disease and gradual mental decline
Brain tissue damage involves shrinkage, loss of neurons, amyloid deposition, altered neurotransmitters and vascular changes such as bleeds and clots
Normally seen in animals >11 years old (but can begin from 7 years)
MRI can reveal brain atrophy and fluid (CSF) build up
NEOPLASIA
Abnormal growth of tissue normally forming a mass
Also known as tumour
Can be benign (non invasive) or malignant (invasive)
Malignant neoplasms are also called cancers
Malignant tumours can invade neighbouring tissue or spread to other parts of the body (metastasize)
Most common sign is weight loss
Hypercalcaemia can indicate malignancy
CATARACTS
INCIPIENT
- only very small portion of lens affected and doesn't affect vision
IMMATURE
- affects 25-90% of lens and can affect vision
MATURE
- Completely opaque lens with poor vision
HYPERMATURE
- Can cause inflammation in the eye
WHITE BLOOD CELLS
HYPERTROPHIC CARDIOMYOPATHY
COMMON DISEASES IN OLDER DOGS
Joint disease
Renal disease
Hepatic disease
Periodontal disease
Weight gain/loss
Cardiac disease
Neoplasia
Senility/cognitive dysfunction
HAC DIAGNOSIS
LDSST more sensitive but less specific than ACTH stimulation test
This means that LDSST more likely to be positive in dog with HAC but may give false positive due to non adrenal illness
LDSST best for dog with clinical signs and no other obvious disease
ACTH stimulation test best for dog with only mild signs or on steroids/phenobarbitone
LDSST involves measuring blood cortisol followed by IV dexamethasone injection followed by repeat bloods at 4 and 8 hours
ACTH stimulation involves measuring blood cortisol followed by IV ACTH and repeat blood 1 hour later
BLOOD INTERPRETATION
BILIRUBIN
BLOOD ANALYSIS
Normal blood ranges vary according to:
COGNITIVE DYSFUNCTION TREATMENT
SELEGILINE
- inhibits enzyme that destroys neurotransmitters such as dopamine and serotonin
PROPENTOFYLLINE (Vivitonin)
- increases blood flow to brain by vasodilation and reducing blood viscosity
S-adenosylmethionine (SAMe)
ANTIOXIDANTS & ESSENTIAL FATTY ACIDS
- Improve brain function and delay decline e.g. Aktivait
HYPERADRENOCORTICISM (HAC)
Also called Cushing's syndrome
Common hormonal disease in dogs
Excessive glucocorticoids (steroids) in body
Can be result of administration of external steroids (iatrogenic), hypersecretion of ACTH (pituitary dependent PDH) or hypersecretion of cortisol from adrenal glands due to adrenal tumour (adrenal dependent ADH)
PDH most common form of HAC due to benign small tumour of pituitary gland in brain (85% cases)
ADH is due to adrenal gland tumour which may be malignant (15% cases)
PDH causes both adrenals to be enlarged whereas ADH causes one adrenal to be large and one small
HYPERTENSION TREATMENT
In cats, amlodipine (calcium channel blocker) is treatment of choice
Other drugs in cats do not reduce blood pressure enough to prevent ocular (eye) problems
Dogs less responsive to blood pressure medicine
First line treatment in dogs is ACE inhibitors such as benazepril (fortekor). Often a second drug such as amlodipine is also needed
Check every 1-2 weeks until normal
Sodium restriction is controversial
SYSTEMIC HYPERTENSION
Persistently high arterial blood pressure
Defined by systolic BP >160mmHg
Sustained elevated blood pressure leads to organ damage especially kidneys, brain, heart and eyes
BP> 180mmHg has severe risk of organ damage
Clinical signs include ocular problems like blindness, neurological signs and heart murmurs
In dogs and cats, hypertension is normally result of vasoconstriction and not high vascular volume
TYPES OF WBCS
CONGESTIVE HEART FAILURE
Results from heart no longer working properly and no longer pumping blood effectively
Leads to blood accumulation in lungs, abdomen and chest
CHF results in poor oxygenation of blood and subsequent circulation which can lead to death
Diagnostics include chest xrays, echocardiograms (ultrasound), ECG (to measure heart rhythm), blood pressure, bloods (including biomarkers such as cardiac troponin, NT-proBNP)
RC SENIOR NUTRITION
Antioxidants
- Vitamins C and E, taurine and Lutein - combat destructive free radicals produced during inflammation
Joint supplements
- Green lipped mussel (multiple nutrients that benefit joint health including ETA), glucosamine, chondroitin sulphate
Polyunsaturated fatty acids
- Omega 3 and 6 fatty acids - anti-inflammatory and coat/skin health
Restricted phosphorus
- slow progression of renal disease
Tartar reducing ingredients
- reduce build up of plaque/calculus
Cognitive support
- L-tryptophan, antioxidants, phosphatidylserine
Added leucine
- stimulates protein synthesis to preserve lean muscle
Controlled sodium levels
- to support cardiac health
BLOOD INTERPRETATION

CALCIUM
RED BLOOD CELLS
Howell Jolly bodies
Suggests regeneration
TREATMENT FOR HYPERTHYROIDISM
DRUGS
- Oral Methimazole blocks T4/T3 production
SURGERY
- Remove one or both thyroid glands
RADIOACTIVE IODINE
- Expensive and not easily available. Given by one injection which is curative
COMMON NEOPLASTIC CONDITIONS
SQUAMOUS CELL CARCINOMA (SCC)
- often affecting nail bed (dog) or face (cat)
ORAL TUMOURS
arising from tonsil, gingiva or tongue - SCC, melanoma and fibrosarcoma
OSTEOSARCOMA
- lameness (bone tumour)
MAMMARY ADENOCARCINOMA
- swelling along mammary chain
BLADDER/URETHRAL CARCINOMA
- dysuria, haematuria
LYMPHOSARCOMA
- Gastrointestinal signs, soft tissue masses, organomegaly
SOFT TISSUE CUTANEOUS OR SUBCUTANEOUS MASSES
- fibrosarcomas, mastocytomas, haemangiopericytomas
SYSTEMIC HYPERTENSION CAUSES
Common in older pets but not obese ones
> 80% of hypertension in pets is secondary to another disease
In dogs, most common causes are renal failure, diabetes mellitus and Cushings
In cats, most common causes are renal failure, diabetes mellitus and hyperthyroidism
CUSHINGS SYNDROME
NEOPLASIA TREATMENT
SURGERY
- excision -> curative or palliative
CHEMOTHERAPY
- Drugs that destroy cancer cells. Usually target rapidly dividing cells. Often used in combination - more than one drug.
RADIATION THERAPY
- Ionizing radiation to kill cancer cells and shrink tumours
IMMUNOTHERAPY
- Stimulate immune system to attack tumour e.g. melanoma vaccine
HORMONAL THERAPY
- Some tumours are hormone responsive e.g. perineal adenomas and testosterone
BLOOD SMEAR
10 X objective (100 x magnification)
OSTEOARTHRITIS
Degenerative joint disease is top cause of chronic pain in dogs and cats
Result of joint cartilage erosion (loss)
Results from long term stresses and inflammation on a joint due to injury or poor joint conformation
Can affect any joint but especially hip, knee, shoulder and elbows
Develops slowly over months to years
Clinical signs include lameness, stiffness and pain
Stiffness often worse after period of rest
Lameness can be constant or intermittent
NEUTROPHILS
Neutrophilia (high)
- bacterial infection, haemolysis
Neutropenia (low)
- bone marrow suppression e.g. Parvovirus and Ehrlichia
Left Shift
- More young (immature) neutrophils
Regenerative Left Shift
- More mature (segmented) than immature (band) neutrophils = inflammation including bacterial infection, haemolysis, pancreatitis
Degenerative Left Shift
- Poor prognosis. More bands than segmented neutrophils
PLATELETS/THROMBOCYTES
THROMOBOCYTOSIS -
Hormonal disease such as diabetes, Cushings and hypothyroidism
THROMBOCYTOPENIA -
Immune destruction or blood parasites such as babesia, ehrlichia
MANUAL PCV
Check colour of plasma after centrifuging:
Red = haemolysis (haemoglobinaemia)
Yellow = bilirubin (jaundice)
BLOOD SMEAR
ANAEMIA
REGENERATIVE ANAEMIA (RA)
= Blood is lost faster than it is replaced
NON-REGENERATIVE ANAEMIA (NRA)
= Failure to produce RBCs in bone marrow
MEAN CORPUSCULAR VOLUME (MCV)
= RBC size - increased in RA
MEAN CORPUSCULAR HAEMOGLOBIN CONCENTRATION (MCHC)

- Amount of Hb in cells - Decreased in RA as larger cells
RETICULOCYTES
- Immature RBCs (larger with RNA) - present in RA
BLOOD SMEAR ZONES
Check feathered edge for platelet clumping
Examine monolayer for RBC, WBC and platelets
OSTEOARTHRITIS TREATMENT
PAINKILLERS:
OSTEOARTHRITIS TREATMENT
SURGERY
- arthrodesis, hip replacement, joint stability
STEM CELL THERAPY
- regenerative cells taken from adipose tissue and injected into damaged joints
WEIGHT LOSS
- less stress on joints
EXERCISE
- low impact, consistent and frequent helps preserve muscle mass and improve joint mobility
ACUPUNCTURE
- pain relief, anti-inflammatory and improved blood flow
HYPERTHYROIDISM
Seen in older cats - normally about 12-13 years
Caused by an excess of circulating thyroid hormones due to benign growth in thyroid gland
Results in high metabolic state affecting many organs
Usually both thyroid glands become enlarged (70%)
Unknown cause - indoor, canned food
Diagnosed by increased T4 in blood
HYPERTHYROID CLINICAL SIGNS
Weight loss despite excellent appetite
Polyuria-polydipsia (PUPD)
Vocal, hyperactive, restless
Intermittent vomiting/diarrhoea
Hypertension
Kidney and heart disease
HEART DISEASE SIGNS
Coughing
Lack of energy
Irregular or rapid breathing
Weight loss
Exercise intolerance
Fluid build up e.g. abdominal swelling
CARDIAC DISEASE
Heart's function is to contract/relax (pump) to maintain good blood flow to tissues and organs in the body
Diseases affecting the heart muscle and valves can cause the heart to fail and eventually lead to inadequate blood flow
Listening to the heart and chest (auscultation) can help determine if heart disease is present
A cardiac murmur (graded 1-6) is an additional "whooshing" sound due to turbulent blood flow
An arrhythmia is an abnormal heart rhythm caused by irregular electrical activity in the heart
BLOOD INTERPRETATION
LOW:
liver disease, gastrointestinal disease (e.g. diarrhoea).
HIGH:
dehydration

GROUP TASK
DILATED CARDIOMYOPATHY
Disease where heart muscle loses ability to contract normally
Heart muscle becomes flabby and weak
Heart chambers dilate with blood
Normally affects left side of heart
Most commonly affects large breed dogs e.g. Dobermans
Irreversible, progressive and terminal disease
Often will have arrhythmia
Can be result of nutritional deficiencies such as taurine and L carnitine
Poor long term prognosis
DEGENERATIVE VALVULAR DISEASE
Small breed dogs tend to suffer from degenerative valve disease (endocardiosis) - mitral and tricuspid valves which leak
Valves become thickened so unable to create tight seal
Endocardiosis leads to regurgitation of blood through leaky valves as heart contracts
Tricuspid valve can lead to Right sided heart failure
Mitral valve can lead to Left sided heart failure
BLOOD SMEAR
40 X OBJECTIVE
BLOOD SMEAR
100 x OBJECTIVE (OIL IMMERSION)
BLOOD SMEAR
Red blood cells (RBC) should appear same size and colour
Polychromasia
= Variation in RBC colour/stain
Anisocytosis
= Different sized RBCs
Polychromasia and anisocytosis consistent with regenerative anaemia
Regenerative anaemia is caused by haemolysis or haemorrhage
BLOOD INTERPRETATION
CREATININE
CATARACTS
Cataracts can lead to:
CARDIAC TREATMENT
DIURETICS
e.g. frusemide - Increases urine production and stops fluid build up such as in the lungs
ACE INHIBITORS
such as benazepril (fortekor) - opens blood vessels (vasodilation) and less sodium retention results in less overloading of heart
PIMOBENDAN
(vetmedin) - Dilates blood vessels and helps heart to pump more efficiently and strongly
SPIRONOLACTONE
- weak diuretic and aldosterone antagonist
OTHERS
- sildenafil, digoxin, diltiazem, sodium restriction, omega 3 FA, beta blockers, anti-clotting drugs
BLOOD INTERPRETATION
GLUCOSE
QUESTIONS???
CHEST XRAY
SENIOR DIETS
REDUCED PROTEIN
- only necessary if significant hepatic or renal disease
LOW PHOSPHORUS
- High phosphorus contributes to renal disease progression
SODIUM RESTRICTION
- Only necessary if advanced cardiac disease
CALORIE ADJUSTMENT
- Normally older animals tend to gain weight and may need less calories. However, some pets may need calorie dense diets if losing muscle/weight
FIBRE
- helps pets with decreased intestinal motility and constipation
SUPPLEMENTS
- Can benefit certain diseases
MEASURING BLOOD PRESSURE
Avoid sedation
Quiet and comfortable environment
Gentle restraint -lateral or ventral recumbency
Cuff should be maintained at same level as heart
Use limb or tail for cuff measurement
Cuff should measure 40% of cuff site circumference
Take about 5 measurements
Confusion/disorientation
- wandering, staring
Poor memory
- housesoiling, forget commands
Altered sleep cycles
- restless, insomnia
Activity levels
- repetition or less active
Less responsive
- to stimuli, family, activities
Non-steroidal anti-inflammatory drugs (NSAIDS) - e.g. carprofen, meloxicam
Gabapentin, amantadine, tramadol, buprenorphine
Steroids as last resort
JOINT SUPPLEMENTS:
Omega 3 Fatty Acids - fish oils
Glucosamine, chondroitin sulfate?
Green lipped mussel
SAMe
Pentosan polysulfate (cartrophen) injections
Most common heart disease in cats
Abnormally thickened heart (ventricle) muscle
Can be genetic or secondary to other disease such as hyperthyroid, hypertension
Normally older cats but can affect any age
Myocardium unable to relax and stretch - unable to fill properly with blood
Can lead to sudden death or blood clots (aortic thromboembolism)
Early signs may include increased respiratory rate or inappetance
Heart can sound normal and cat asymptomatic
Treatment depends on complications (e.g. glaucoma) associated with cataract, retinal health and general health of animal
Blindness
Lens luxation
Uveitis - inflammation of eye
Glaucoma - high eye pressure
Treatment involves surgical removal or phacoemulsification (physical dissolution) to restore vision or resolve pain
95% vision rate is restored immediately post-op and 80% long term vision success
HIGH
- Liver or bone disease, young growing animals, steroids (e.g. Cushings)
ALBUMIN:
ALKP - ALKALINE PHOSPHATASE
HIGH:
Diseased or damaged liver.
AMYLASE AND LIPASE
HIGH:
Pancreatic disease (pancreatitis), liver disease, intestinal disease, reduced kidney clearing
BILE ACIDS
HIGH:
Liver disease (pre and post prandial)
HIGH:

Liver or gallbladder disease. Excessive red blood cell destruction (haemolysis).
Produced by liver to breakdown fats
Produced by pancreas and intestine and amylase removed by kidney
Produced by liver
Produced by liver. Low levels cause fluid leakage from blood vessels - oedema, ascites etc
Produced by liver from old red blood cell (haemoglobin) breakdown. Stored in gall bladder as bile and excreted by intestine.Makes skin colour yellow (jaundice)
BUN - BLOOD UREA NITROGEN
Waste product produced from protein by liver
HIGH:
Kidney disease, dehydration, high protein diet, GI ulceration
LOW:
Liver disease or low protein diet.
HIGH:
Malignancy (cancer), chronic kidney failure, hyperparathyroidism
LOW:
Late pregnancy or during nursing/lactation (eclampsia), parathyroid issues , intestinal and kidney disease
CHOLESTEROL
Cholesterol is type of fat. Not associated with heart disease. Less affected in cats
HIGH:
Many diseases can cause high levels including diabetes, Cushings, kidney disease and hypothyroidism
Produced from muscles and passed out via urine. High BUN and Creatinine is called azotaemia
HIGH:
Dehydration or kidney disease.
CREATININE KINASE (CK)
Produced from damaged muscles
HIGH:
Muscle damage e.g. trauma, seizures
HIGH:
Diabetes mellitus, Cushings, feeding and stress
LOW:
Severe bacterial infection (sepsis), pancreatic disease, seizures, liver disease, anorexia (especially young)
PHOSPHORUS
HIGH:
Chronic serious kidney disease or growing animals
TOTAL PROTEIN
Albumin and larger proteins (globulins and fibrinogen)
HIGH:
Dehydration or immune system activity e.g. infection
LOW:
Liver or kidney disease, malnutrition, intestinal disease, blood loss, skin loss e.g. burns
HIGH:
Dehydration, high sodium diet, Cushings, chronic renal disease
LOW:
Addison's disease, diuresis, fluid therapy, fluid loss, hypothyroidism
POTASSIUM
HIGH:
Addison's disease, acute renal failure, urinary blockage, haemolysis, major tissue trauma
LOW:
Excessive loss by vomiting and diarrhoea
Count number of leucocytes (white blood cells - WBC)
Average number per field x 0.334 = approximate total white blood cell count
Normal total WBC should be about 6-17 x 10*9 cells/L
Normal number of WBCs per field is 18-51 cells
Normally 1-3 WBCs per field
More than 10 polychromatic RBCs per field - marked regeneration (haemolysis and possibly haemorrhage)
RBCs evenly spaced not overlapping but no gaps to add additional cells
Increased spacing between RBC = anaemia
Overlapping RBC= dehydration or polycythaemia
10-30 platelets per field
< 5 platelets/field = thrombocytopaenia
> 30 platelets/field = thrombocytosis
NOTE: Any platelet clumps at feathered edge nullifies count
Spherocytes - dense dark rbcs
seen in IMHA (haemolysis)
Schistocytes - RBC fragments due to physical trauma e.g. heartworm
INFLAMMATION
- band cells (immature neutrophils), eosinophils and monocytes
MONOCYTES
- tissue necrosis e.g. pancreatitis, haemolysis
LOW LYMPHOCYTES
- stress (steroids)
HIGH EOSINOPHILS
- hypersensitivity (allergies, autoimmune) and parasites
EOSINOPENIA
- haemolysis, bone marrow suppression, heart failure
LYMPHOCYTES
- antigenic stimulation causing antibody production
BASOPHILS
- similar to eosinophils
GLOBULIN
HIGH:
Stimulation of immune system - inflammation
Protein of immune system (immunoglobulins)
Age
Breed
Species
Stress
Feeding - diet and timing pre-testing (fasting?)
Medication e.g. phenobarbitone and steroids on ALKP
ALT
ALKP
CHOLESTEROL
BUN (UREA)
CREATININE
PHOSPHORUS
SODIUM
CREATININE KINASE
GLUCOSE
Explain which general factors can affect normal blood values and also the main causes of altered blood values (higher and lower) for the following tests:
POTASSIUM
BILE ACIDS
AMYLASE/LIPASE
CALCIUM
ALBUMIN
TOTAL PROTEIN
GLOBULIN
BILIRUBIN
IDENTIFICATION
Clinical signs include polyphagia, PUPD, pendulous abdomen (pot belly), panting and muscle wastage
Skin may appear thin and mineralised (calcinosis cutis) and alopecia
Complications include diabetes mellitus, hypertension, ACL rupture, blindness
Most common lab findings are increased ALKP (also increased ALT and cholesterol) and dilute urine (low specific gravity)
Diagnosis includes ultrasounding the adrenal glands
Low dose dexamethasone suppression test (LDSST) and ACTH stimulation test are used to confirm HAC
HAC TREATMENT
SENIOR CONSULT STAGE 1
MANUAL PACKED CELL VOLUME (PCV)
PLATELET CLUMPING
SENIOR CONSULT STAGE 2
HAC complications include Adrenalectomy (surgery) to remove adrenal gland if ADH
Early treatment for PDH may prolong survival time and prevent some complications
Median survival time for treated dogs is 30 months
Treatment can cause adrenal necrosis, Addisons and possibly death
HAC treatment is recommended if hypertension, recurrent infections, proteinuria or clinical signs are troubling owner
Daily trilostane blocks an enzyme which produces steroids
Mitotane destroys adrenal cortex which produces steroids (initially daily dose for a week then once weekly)
Cats over 7 years old
Cats with no signs of ageing
Lowered phosphorus content to maintain kidney function
Anti-oxidant balance to protect against oxidative stress
Contains phosphatidylserine for brain
Branched amino acids that can slow tumour growth and help preserve muscle mass
High fibre to help gut motility
Optimal energy density for ideal body weight for mature cat
Same as Stage 1 except for following differences:
For cats showing signs of ageing
Joint supplements such as GLM and EFAs
L-tryptophan for brain function
High energy and fat as older cats have decreased fat assimilation and increased energy requirements
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