Ok, thank you. That is helpful.

I was going to say it is possible that the BM accidents were precipitated by the cystitis as some cats will associate the litter box with the pain of a specific disorder, but if she was having the accidents before, that is less likely the case. It is possible that she was having some discomfort before she developed the other symptoms of the cystitis (that alerted to you it) and that could have been involved. In any case, if the UTI has now been verified to be resolved, even if that was the case, you should be able to get her back to the box.

One other thing to consider is that she may be choosing to go next to the box if she is having any discomfort getting into or out of the box, especially if the sides are high and she is starting to have any arthritis. Most cases of litter pan aversion start when something unpleasant to the cat turns them off to going back to the box. It may have been that she stepped in it while it was dirty or something scared her one time while she was in the box and she associates that unpleasant experience with the box. The goal is to make the litter boxes the most attractive place in the house and the other spots less attractive. The general rule of thumb is to have one more litter pan than you have cats, so it looks like you already have that covered. You must scoop daily! Cat's are also very texture specific so look at the places she is choosing to go.

If it is a carpet, you may want to put a piece of scrap carpeting in a litter pan for her. If it is hard flooring, you could try an empty litterbox. You may also want to try a box with very low sides to see if that may help (more like a tray). You may have already tried these, but they are suggestions that have helped many of my clients. Litter pan hygiene is key.

Anxiety about something can sometimes be part of the problem. Feliway® is a product that can be sprayed or used as a room diffuser and emits a feline pheromone. It is not perceivable to us, but is supposed to be calming to her. It is always a good idea to have this around as sometimes the cause is an anxiety she is feeling, and may be even unperceived by us. (other cats outside, other cats in the house, changes in the house, etc).

Finally, it may be that she is starting to exhibit early behavior changes due to an aging brain. It is not uncommon to see intermittent signs of senility in older cats displayed by any variety of symptoms including wandering aimlessly, staring off in space, seeming unaware of surroundings, night howling or hypervocalizing, having changes in sleep wake cycles, seeming slightly disoriented at time and urinating and defecating outside the litter box intermittently.

Cognitive dysfunction syndrome is a well recognized disorder in aging dogs and cats, however so many other health issues that occur as pets age sometimes interfere with our recognizing it especially in it's early stages. There are supplements that can be helpful to improve these signs and slow the progression of decline, but it is necessary to rule out any underlying health issues first. I am listing the supplements that have been used with some success for some cats and are a good first choice before adding any drugs.

Omega 3 fish oils - (in higher concentrations) - The active ingredient of fish oil is EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid). You just want to make sure you are seeing those on the label as an ingredient and not just the words "fish oil" as these are the important part of the fish oil and not all fish oil capsules have them in it, especially the cheaper ones. Aim for 150 mg of EPA and 100 mg of DHA. There is a large range of safety and it doesn't have to be that amount exactly but this gives you some guidelines.

Senilife® for cats- contains components to support healthy brain function as well as resveratrol, Ginkgo biloba and vitamin E to provide antioxidant protection.

As far as drug therapy, there is an approved medication for use in dogs, but as of yet is not approved in cats although it has been used with fairly good results and no side effects. It is called L-Deprenyl or Anipryl® and works by increasing the important brain chemicals that decline with age. It also helps to helps reduce amounts of free radicals in the brain which can be damaging to the remaining tissue. This is an option if the supplements are not helping.

I would work with your vet to try incorporating the above mentioned ideas, maybe incorporating one at a time.

Finally, you can help stimulate her brain by simply providing the daily enrichment and stimulation at a level that an older cat can handle. Play with her and keep her senses sharp. Her brain needs the same type of support as the rest of her aging body.

Here is a link with more ideas to help with environmental stimulation and enrichment:

Indoor Pet Initiative: http://indoorpet.osu.edu/

I hope this is helpful. If you would like any additional information or have additional questions please don't hesitate to ask!

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