A super what now?

Dear s.e.,

I know this isn't exactly an imminent loss question but it is raising some "oh no, my cat really is old" questions for me. At my cat Chloe's annual exam last month, my vet said she's a "super-senior" now and recommended a "senior panel" and some other things. It kind of reminded me of being at the car dealership where you go to get your oil changed and they tell you that while you're in, you need to do some other mysterious thing or your car will fall apart on the highway.

What exactly is a "super senior" (the internet tells me it's a cat over 13, or 15, or 16??) and how many of these extra tests she really needs? Chloe is 15 and the light of my life, so I don't want to be stingy about the vet care she needs, but I also don't want to do anything unnecessary or stressful for her.

—Running an Old Folks' Home Now Apparently??

Howdy!

First, congrats to you and Chloe on living what sounds like a great life!

This is a great question because it intersects with so many things: Our changing relationship to our animals, emerging trends in veterinary medicine, and the complexities of the relationships between vets and their clients in an era when PE is ruining everything (capitalism has once again entered the chat).

We'll tackle the easy part first: "Super senior" seems to have emerged within the last couple of years to describe both dogs and cats who are, colloquially, older than dirt. With cats, I've heard anything from age seven (!!) to ten marking the transition between being an adult to a senior, and apparently we need a whole new category (like they did on the air quality map when off the charts readings started showing up during wildfires). As you discovered in your attempts to get answers from the internet, people can't seem to decide on when a cat goes from being a senior to a super senior, although many people seem to be landing around age 15.

One amazing things about advances in veterinary care and changes in human-animal relationships is that animals are living longer—indoor cats can live into their late teens or early 20s. I'm not convinced that we need a special "damn this cat is REALLY OLD" category, but there definitely are some health concerns to consider with senior (and super senior) pets, just like humans. Some remain highly active with no major issues throughout their old ages; others may get a little thin and scrungly but are otherwise living their best lives; but there's also a risk of more serious age-related health problems like kidney disease.

Those health risks are probably what your veterinarian was thinking about. At a minimum, it's a good idea for senior pets to get an annual exam, which also gives the vet a chance to talk with you about how your pet is doing and if you're noticing any changes. Some basic testing to go with that exam can be helpful. The necessity of additional testing can depend on...a number of factors.

I do think a senior panel can be a good idea. I don't get kickbacks from the veterinary industry but my cat Ash is somewhere between 11-13 (he has TERRIBLE teeth that make it hard to ascertain his age and he was picked up as a stray by animal control), so I do get an annual senior panel for him. When Tricycle gets older, he'll also get senior panels, assuming the world hasn't fallen into chaos or nuclear winter by then.

Think of it akin to annual bloodwork you may get as a human, which is a pretty common part of routine preventive care. Usually it includes both blood and urine testing, with a complete blood count as well as checking for indicators of diabetes, kidney disease, or even tumors. If her values are looking good now, great! Now you have a reference to compare them to in the future and she gets a gold star.

If they're not looking good, you just spotted health issues early so you can intervene quickly. For example, Chloe might have early-stage diabetes and if you spot it now, some changes can make a huge difference in her quality of life as well as her lifespan. Last year, Ash had some moderately worrying kidney values, I made some changes to his diet, and this year, they were back to baseline. If I hadn't done the panel, his kidneys might have gotten progressively worse until they reached the point where he was having obvious symptoms that could be expensive and hard to treat.

HOWEVER, we also live in an era where private equity is ravaging the veterinary profession. You didn't mention whether your vet is at an independent clinic or a chain one, but it's important to be aware that chains like VCA and Blue Pearl are owned by corporatists looking for profits and seeing our love for animals as a wide-open cash register.

Some push their veterinarians to make quotas for tests ordered and procedures performed, to the point of having a literal leaderboard in the back office. Vets will get penalized for not meeting their numbers. It's ugly out there for people who became veterinarians because they want to provide health care and supports for pets and people.

Understandably, many vets hate working in corporate practices but they're backed into a corner. These clinics are eating up so much of the market share that it's hard to find work elsewhere. Startup costs for setting up your own clinic are really high. Shelter medicine doesn't pay well. They have hundreds of thousands of dollars in student debt. It's a really terrible place to be stuck and many do their best in a bad situation.

They find quotas unethical and disruptive to their practice of medicine. They don't want to be ordering expensive tests animals don't need, or pushing treatments that aren't warranted. Meanwhile, pet guardians faced with these expensive recommendations and an awareness of how PE influences operations at veterinary clinics might start to wonder if they are indeed at the car dealership and you're dealing with a salesperson, not a veterinarian.

Suggesting a senior panel is a totally reasonable thing to do and it's aligned with veterinary best practices (always worth looking up clinical recommendations when things like these come up, and the AAHA does, in fact, have some guidance on senior pet care). Whether you're at an independent or chain clinic, your vet is recommending it because they genuinely care about Chloe and think it's the smart move for her health. It's relatively non-invasive testing and the risks are very low; if Chloe HATES being at the vet, it can be a bit stressful, but I think it's worth it (if she gets REALLY upset, you could talk to the vet about giving her gabapentin or another sedative to make her feel more comfortable).

If the vet is recommending other tests, though, it's okay to ask questions and push back, especially if she has a pretty unremarkable medical history and doesn't have any risk factors that might raise concerns. For example, if they say Chloe needs x-rays, ask why: What clinical issue leads them to think that diagnostic imaging could be useful? How many, and which views, does the vet recommend? If the vet wants to do an ultrasound, again, what's the clinical indication? A 15-year-old cat who's in generally good health probably doesn't need an MRI, you know?

In that conversation, it's also reasonable to ask not just why the veterinarian recommends the test, but what next steps might be, depending on the outcome. For early detection and prevention, diagnostic screening can be outstanding. But it may also turn up something that could lead you down a costly and frustrating path that doesn't necessarily improve Chloe's quality of life. You may feel pressured to get additional testing or treatment that might have limited benefits for Chloe because what kind of monster wouldn't want to follow up on a concerning finding? Some age-related issues (like Ash's high kidney values) are a blip and may resolve with minimal intervention...and in some cases, they're stable and chronic, and your pet is more likely to die with than of them, which is something to consider as well.

Tell your cat I said...

Age is just a number (but just in case, let's check your kidney numbers)