An opinionated feline in Edmonton, Canada who lived with a retired cat behaviourist, Greyce provided behavioral advice to cats in need until her death in July 2014. Because her entries are useful even today, the blog remains posted.

Thursday, February 11, 2010

15 Things to Ask about Medication

I promised in the Urine Marking Series that I'd deal with the issue of medication. While I'm not going to give you a list and let you choose what you think may be right for you, I am going to help you prepare for meeting with your veterinarian, so you will know what you are getting, why you are getting it, and how best to deal with it.

But first, a warning: When you are ill, say with a bacterial infection, and you take an antibiotic you are pretty much guaranteed that you will get well if you take the prescription correctly. It doesn't quite work that way with behaviour problems. In this case, medication is one, but only one, important element in helping you recover. Say you are spraying and the vet gives you a drug; that tablet may very well lead to a decreased amount of spraying. But to truly get better you need a behavioural program (a set of actions taken with your folks' help so you can learn more acceptable behaviour, remove cues that encouraged the problem, and modify your environment to enable you to cope better). In other words, when it comes to the a behaviour problem:
  • Medication alone does not solve the problem.
  • A behaviour program alone usually does not solve the problem (unless it is very recent and the intervention is fast and appropriate).
  • Medication + a behaviour program give you a much better chance of success.

So if you are on medication for a behaviour problem and your folks have done 'diddly squat' else to help you, you are going to have that behaviour problem for a very long time. Encourage your folks to get help. Some veterinarians will provide general advice and some will provide details. Some can arrange for you to have a distance consultation with a veterinary behaviourist. And there are always non-veterinary behaviourists who may be able to work with you and your veterinarian as well. It will depend on what resources are available, where you live and what your folks are willing to pay.

Depending upon your veterinarian, you may be given a pharmaceutical (a drug), an herb, or a homeopathic remedy. Even within one category of medication, like drugs, there are many possibilities. It is up to your veterinarian to make the selection that is in your best interest.

Some medications can complicate certain kinds of existing conditions. For example, some medications are often hard on the kidneys and liver (which processes them). Even homeopathic remedies need to be used with care. That is why you will need a medical exam (including a history of other medications you are taking - even vitamins or herbal treats) BEFORE your get your prescription, regardless of the medication used. In most cases, you will need to give a blood sample unless you have had recent bloodwork. The reason is simple: Suppose you look quite healthy but show some signs of, say, kidney problems, as a result of your bloodwork. In that case, the vet would have to select an appropriate medication that will not interfere with or make that problem worse. It is also the reason that you may have to have your blood monitored from time to time. (Don't worry it is usually not every month.)

But it is not only the veterinarian who needs to be 'on the ball'. The inquiring cat should make sure to be well-informed before leaving the clinic with any drug. Here is what you need to know:

1. Drug’s Brand and Generic Names. There is nothing worse in a behavioural consultation than to be told you are on a medication but that you and your folks don't have a clue what it is! And should you have to see another veterinarian for any reason (say, in an emergency), that purrson needs to know.

2. Purpose for giving this medication. In other words, what is this being used for? It sounds like common sense but think about it. If you are spraying, you might be given a medication that will help you by reducing your anxiety, or you could be given one that will increase your assertiveness - depending on the nature of your situation. Obviously, you'd expect to be more mellow on one and purrhaps more fiesty with the other. If I were you, I'd want to know!

3.  What changes can be expected with using this medication? How long does it usually take before I should be able to notice some change? How long does it usually take, before my body will have fully adjusted to this?

4. What are the side-effects? How common are they? And yes, herbal preparations and homeopathic remedies can have side-effects, too. Will these side-effects last all the time the medication is being taken or only while I get used to it? For example, some medications may cause you to be drowsy or lethargic for the first day or so. And if you know that and continue to feel drowsy after those days are passed, it is time to call the vet!

5. Should I call you if I notice any side-effects? Is it important that I call as soon as I notice them? Some particular side-effects may indicate that you need help immediately; others, not so much. Sometimes it is only necessary to mention them at your next visit.

6. When (and how often) do I take this medication?

7. How do I take this medication? Obviously you will need your folks to help and some of them may be great, say, at pilling you and others, terrified. Give them the courage to ask that they be shown how to administer the medication to you.

A word to the wise: Veterinarians and veterinary technicians pill cats, prepare injections, etc. every day. So to them it is no big deal. But it can be scary to someone who has never done it. And it takes practice. Just one 15-second demonstration will not be enough. So make sure your folks are assertive enough to get the information they need before they leave the clinic.

Herself is scared to pill me, so Himself does the honours when it is necessary. But even he had quite a learning curve. Since I had to be on medication for a kidney infection for six weeks, they hired a veterinary technician to visit daily for a week. She showed them how to pill me and let him practice under supervision. This got his confidence up and when he was no longer anxious, I was less so as well. And then we could manage on our own.

8. Can I take the medication in food or a treat? Note: Some can’t be crushed because the pill is too bitter; others must be given on an empty stomach (which means your folks have to monitor your food bowl if you free feed, to make sure you haven't eaten; they may even take it away between meals); still others must be given with food to avoid stomach upset.

If it is okay to take with food and you like them, Greenies makes Pill Pockets which some of you might prefurr. You just have to like the taste (chicken or fish flavour). They are soft treats with a slit in them where the pill goes in. The big thing is that your purrson cannot close the pocket with the same fingers that put the pill in, or you will know something is up. Herself uses a pair of tweezers to foil me. I can take a pill pocket in the morning when I first get up (and even then they pull off part of the pocket so it isn't too much for me to eat), but I don't like it at other times of the day. Some of my colleagues refuse them outright; and some adore them. Go figure!

9. Is there anything I should NOT be taking while on this medication (e.g. drugs, herbs, homeopathic remedies, supplements, specific food treats, vitamins)?

10.  What are my options if I refuse to take this drug and my folks are too scared (or clumsy) to administer it? Many (but not all) medications either come in varied forms or can be compounded, that is, prepared at a special pharmacy that makes them in other forms (like a gel that can be applied to your ear or a chicken-flavoured liquid). But again you need to ask questions. Some topical gels need careful application or you will not be getting a consistent dose. And if the medication is particularly vile, just adding chicken flavour won't do a thing for you. And I should know because this happened to me. I was given medicine for diarrhea and Herself got it compounded in chicken-flavour; it was so awful tasting (even with the flavouring) that I really put up a fight. Good news: some clinics can arrange to have a veterinary technician come to your home and administer the medicine.

11. What should I do if I miss one dose? Sometimes it's okay to give it as soon as you realize you missed it. Other times not. And sometimes, doubling up on the dose can be very serious.

12. What should I do if I accidentally overdose ? Example: I upset the bottle and eat more than one pill. (Obviously we all hope that if another pet or a child gets the drug, instead, that your folks have the moxie to call your vet or the family doctor, as appropriate.)

13. How long will I be on this?

14. When it is time to stop taking the medication, is there a weaning process? Please explain. Note: It can be very dangerous to stop 'cold turkey'.

 15. Who should I call if I have any questions or problems? Who should I call if I have any problems AND the veterinary clinic is closed?

And if you have the choice and go to a clinic that is closed on weekends,  ask if it is okay to start the medication at the beginning of the week. That way if you notice side-effects you can easily contact the clinic before it closes.

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