Friday, July 28, 2017

Inhaled Medications: Another Option for Medicating Your Cat

            Cats can be tricky to medicate.  Veterinarians know that it is difficult to medicate a cat consistently with a medication that is required twice daily, and almost impossible to administer a medication reliably and unfailingly three times daily.  Most veterinarians, when dealing with cats, try to strike a balance between efficacy and ease of administration, prescribing the most effective drug that can be given with the least frequency. 

Medications that come in pill or capsule form are especially challenging, as many cats actively resist having pills put down their throats. Uniquely designed treats, such as “Pill Pockets” are available in some pet stores and veterinary offices. These are soft treats with a hole cut out of the center. Pills are placed in the center of the treat, and are then sealed inside by gently squeezing the sides. Some cats can be tricked into taking pills this way for months, although many catch on to the ruse and will eventually refuse to eat the treat.

Cat owners often find liquid medications easier to administer. Fortunately, a number of pharmacies now offer compounding services - they can convert medications traditionally available only in capsule or tablet form into other formulations, such as a liquid form, often adding chicken, liver, beef, and tuna flavoring if requested. While most cats do not like having any medication forced upon them, many find a tuna or chicken flavored liquid less objectionable and a few will take a flavored medication voluntarily.

A number of pill-hating cats will also resist liquid medication, regardless of the flavor. Transdermal medication (delivering drugs into the bloodstream via application of gels or skin patches) offers another option of medicating cats that simply refuse to take any medication orally. Some medications can be compounded into a gel, a small amount of which can be spread on the inner surface of the ear.  The medication is then absorbed through the skin, into the bloodstream, allowing owners of stubborn cats to bypass their mouths completely.  While transdermal drug administration is becoming more commonplace in veterinary medicine, there are only a few drugs for which efficacy has been proven with this method.  Just because a drug can be formulated into a transdermal gel doesn’t mean that therapeutic blood levels of the drug can be achieved. 

            Inhaled medications present another option for medicating cats, however, the use of inhaled medications is limited to cats with respiratory ailments, most notably asthma.  Interestingly, veterinarians seldom prescribe inhaled medications because of the difficulty of administering oral medications to a cat.  Rather, inhaled medications are often given because of the reduced risk of side effects when using inhaled medications. 

Veterinary Technician/Cat Whisperer Gill Nunes demonstrates
how to administer inhaled meds to little Trinity.
            Asthma is the most common reason for prescribing inhaled medication in cats. The most effective long-term treatment consists of high doses of oral steroids.  Steroids attenuate the inflammatory response, reducing the severity of signs.  Steroids are given twice daily for several days.  Most newly diagnosed asthmatic cats will feel and act much better, at which point, the steroid dose is tapered slowly over several weeks.  Unlike dogs, cats are fairly resistant to the undesirable side effects of steroids.  A few cats, however, exhibit adverse effects from steroids, making treatment challenging.  Oral steroids cause water retention, which increases a cat’s blood volume.  Cats with heart disease may not be able to withstand the increase in blood volume, putting a strain on an already compromised heart and triggering congestive heart failure.  Oral steroids also oppose the action of insulin, and can cause a well-regulated diabetic to become poorly manageable.  Some cats may be pre-diabetic, and giving oral steroids can tip them over the edge into overt diabetes.  Inhaled steroids, when administered, exert their effects almost exclusively in the lungs.  Very little of the drug crosses beyond the lungs into the bloodstream, so systemic side effects are minimized. 

Be warned: not all cats will be as cooperative as Trinity. 
            Bronchodilators are drugs that reverse airway constriction, allowing the air passages to open.  Although most asthmatic cats can be managed with steroids alone, some require a bronchodilator in addition to the steroid.  Bronchodilators can be given orally, although an advantage of inhaled bronchodilators is their rapid effect, which may be lifesaving in severely asthmatic cats that are prone to acute asthma attacks.

            Both types of drugs are available for humans, as metered dose inhalers (MDIs).  Human adults quickly learn to coordinate the inhaling of the medication with the actuation (pressing) of the device, although this is much more difficult for children, and impossible for infants or cats.  An alternative was developed to allow children, infants, and cats to use the MDIs without having to coordinate their breathing.  A spacer – a plastic chamber roughly the size of the cardboard inner tube of a roll of toilet paper – is attached to the MDI, and a facemask is attached to the other end.   The spacer acts as a temporary storage area for the misted medication to sit, until the individual breathes it in. Cat owners are taught to attach the MDI and the facemask to the spacer, and then to actuate the MDI twice, filling the spacer with the mist.  The facemask is gently placed over the cat’s mouth and nose, and the cat is allowed to inhale and exhale 7 – 10 times with the mask in place.  The most popular device for inhaled medications in cats is the Aerokat (see pictures above)

             Inhaled steroids are the most potent inhaled anti-inflammatory drugs available.  Fluticasone (Flovent) is the most commonly used inhaled steroid.  As for bronchodilators, Albuterol (Proventil) or Ventolin) is the one most commonly used for asthmatic cats.

            Inhaled steroids and bronchodilators have been the standard of care for the treatment of asthma in humans, and while oral medications are still the initial method of treatment for asthmatic cats, inhaled medications offer another option for cats at risk for or experiencing side effects of oral medications, or for cats who refuse to allow oral administration of medication.


Wednesday, July 12, 2017

Cat Man Adieu

It’s been a little over a month since I retired.  I’m still finding it hard to get used to.  I overhear other people say, “I’m not working the rest of this week” or “I’m off for the rest of this month”, and I realize that hey, I’m off for the rest of my life. 

There are many things to adjust to.  I suppose the most noticeable thing for me is the silence.  As a veterinarian, I used to spend my day talking to clients during appointments.  If I wasn’t in an appointment, I was likely talking to a client on the phone.   If there were surgeries or procedures to perform, I’d be chatting with my staff in the treatment room before, during, and after the procedure.  My entire day was spent in some type of conversation.  In retirement now, I go through the day barely speaking a word to anyone.  Most days, the extent of my conversation is, “I’ll have the chicken salad club and an iced tea”, or “Can I have the venti green tea frappuccino?” (I’ve been saying that one a lot lately) I’m a social, outgoing person, and the curtailment of my conversation is the most striking difference in my day.

The lack of a set routine is probably the next most noticeable change.   My day was used to be pretty much the same: wake up, shave, shower, feed the cats, have breakfast, do a few household chores (laundry, dishes, litter box), and then descend into the hellish subway to work (thankfully only 5 stops), and then see appointments all day.  That routine is now gone, but being a creature of habit, a new pattern is starting to emerge to my mornings.  Sadly, I’m still getting up very early, because Mark (the hubby) still has to wake up at the ungodly hour of 5:20 a.m.   While he hops in the shower, I feed the cats and make breakfast for us both. (I’m getting very skillful and creative with omelets.) I complete a few more chores, and then I accompany him out the door at 6:30.  He walks to 14th Street to catch the van that takes him to work, and I peel away when we approach 27th Street and hit Planet Fitness.  Yes, I’m going to the gym for nearly 2 hours every single morning. 

Twice a week, I do a little grocery shopping at Fairway after the gym.  Otherwise, I come home, do a few more chores, shave and shower, read the New York Times headlines (delivered to my inbox every morning.  I’ve figured out how to work around their ten-article-a-month firewall), answer a few e-mails, and then confront the agonizing decision about where I’m going to have lunch.   As for my afternoons, they’re open.  Some days, I go to the mid-Manhattan library and either borrow some books, browse their books, or read a book that I’ve brought with me.  At least once a week, and sometimes twice, I catch the 1:30 movie at MoMA.  I’m a member, and so the movies are free for me.  These are usually old movies from the 30’s, 40’s, and 50’s, being shown as part of some actor/actress/director retrospective.  After the movie, I usually hang around and read in the sculpture garden.  Most of my afternoons are spent reading (and occasionally napping) in a park.   Some days (usually if I’m feeling a bit lonely or isolated) it’s Bryant Park.  Other days, it’s Madison Square Park (usually on days when I eat lunch at Eisenberg’s Sandwich Shop, because it’s close by).  Mostly, I head down to Tompkins Square Park.  It’s a little out of the way, but on weekdays it’s really peaceful and quiet, and I have a particular bench in a perfect, shady spot that is ideal for people-watching.  Rough life I lead, eh? 

I suppose the other major change since retirement is a so-called “lack of sense of purpose” that I’ve been warned about.  Two retirement books that I’ve read have mentioned this potential issue.   And yes, I can see how this can be an issue, and may end up being one for me in the future, given how strong a sense of purpose my career as a veterinarian had given me.   It so happens, this lack of a sense of “purpose” that I’m currently experiencing has actually turned out to be the most liberating and calming part of my retirement.  For 29 years, my purpose was to help sick animals become well, and help clients deal with all issues regarding their pets’ health, while mentoring students, interns and technicians along the way.  It was a huge responsibility (more on that in a future post).  Being free of all of that, for the moment, is a huge (we’re talking ginormous) weight off my shoulders.   Of course, at some point, the urge to do something more meaningful will be upon me, and I will pursue it wherever it leads (although I have a strong hunch that veterinary medicine won’t be involved), but for now, I really want to harken back to the days when I was a kid in Brooklyn and had the summers off.  I spent those summers playing stickball and stoop ball, riding my bike, and hanging out in the neighborhood park with my friends.  Forty-something years later, there won’t be any stickball or stoop ball, but I’m definitely on a mission to check out every little park in Manhattan.

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