CVC Central 2007 Highlights: Practical ideas for managing common internal medicine problems - Veterinary Medicine
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CVC Central 2007 Highlights: Practical ideas for managing common internal medicine problems
The following tips—5 each for dogs and cats—are easy to implement and will improve your patient care.


VETERINARY MEDICINE


CATS

#1 Suspect food allergy in cats with intense head or neck pruritus. The degree of self-mutilation and excoriation that occurs in cats with food allergy can be dramatic. Other differential diagnoses include ear mites, atopy, otitis externa, and scabies. However, cats with these conditions typically do not demonstrate the same degree of self-mutilation. I recommend a strict novel antigen diet; most patients show dramatic improvement within a few days.

#2 Learn to place esophageal and gastric feeding tubes. Cats need feeding tubes in cases of hepatic lipidosis (any tube), esophageal disease such as doxycycline-induced esophageal stricture (gastrostomy tubes), chronic renal failure (any tube), or any other disease that doesn't affect gastrointestinal function but suppresses a cat's appetite. I like esophagostomy tubes because they don't require special equipment and are easy to place. In cats with hepatic lipidosis, use a naso esophageal tube for a few days to feed and help stabilize these cats before administering anesthesia for esophageal or gastric feeding tube placement.

#3 Do not leave a polypropylene urinary catheter in the urethra of an unblocked male cat. Replace it with a polyvinyl or red rubber catheter. Polypropylene (used in Tom cat catheters) tends to be irritating to urethral mucosa and can cause urethrospasm once the tube is removed, often resulting in a cycle of recatheterization and additional irritation. Polyvinyl (used in infant feeding tubes) and red rubber catheters are nonreactive. If you must leave a polypropylene catheter in, administer an antispasmodic such as prazosin from the beginning. All catheters should be attached to a closed, sterile collection system.

#4 Use prednisolone in cats, not prednisone. Sometimes cats fail to respond to prednisone because the diagnosis is wrong and they don't have a corticosteroid-responsive disease. But sometimes they fail to respond because they can't convert prednisone to the active form, prednisolone. Eliminate the potential for treatment failure based on poor hepatic conversion by giving prednisolone to all cats that require oral corticosteroid therapy from the start.

#5 As an alternative to lactulose in cats with chronic constipation or hepatic encephalopathy, try milk or cream. Lactulose is effective because there is no enzyme to digest this disaccharide; thus, the disaccharide stimulates osmotic diarrhea. Most cats are lactose-intolerant and will have a similar response to milk. Cats frequently hate the taste of lactulose but love milk. Titrate the dose to soften stools.

BONUS TIP

Lime sulfur is still the most effective antifungal for treating dermatophytosis. Sure it stinks, but it's safer than griseofulvin and cheaper than fluconazole or itraconazole. And it more effectively eliminates dermatophytosis than any of those products combined.

Kenneth R. Harkin, DVM, DACVIM (small animal internal medicine), Department of Small Animal Internal Medicine, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506.

REFERENCE

1. Hale DE, Bennett MJ. Fatty acid oxidation disorders: a new class of metabolic diseases. J Pediatr 1992;121(1):1-11.


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Source: VETERINARY MEDICINE,
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