Allergies

When I think of allergies, I think of horses. 

When the topic of allergy comes up during an appointment, I brace myself for the look of confusion on the clients face.  Very few people readily accept the idea that their cat has an allergy because many owners look at cats as a low maintenance pet that isn't supposed to have wierd problems.  The most difficult discussion I had regarding allergies occured on my dermatology rotation in veterinary school.  We had a horse with chronic skin disease that had seen several different vets and tried many different therpies before they came in for a referral to Texas A&M.  After doing what needed to be done, we were confidant in the diagnosis, yet the client argued incessantly as if eventually we would say "just kidding".

Unforunately, getting past that difficult conversation can seem easy relative to what may follow.  Here are some highlights...

• Everyone wants problems to go away permanently - with allergy one hopes for control rather than cure.
• Sometimes it can take many months before an effective regimine will be found - be patient.
• There are many tests that may need to be run first including culture, skin scrapes, blood analysis, and biopsy.  The cost of a dermatology workup CAN be significant.
• A cat with flea allergy many have absolutely no evidence of fleas because the cat has cleaned up the clues. 
• If  food is the culprit, that "lamb and rice" food likely isn't going to cut it.  True allergy foods use either extremely exotic proteins or something called hydrolyzed proteins.
• A cat with food allergy may not positively respond to all of the allergy diet options.  If the first one doesn't work after 30 days, try another.
• The "blood allergy testing" that Dr. Google likes doesn't work well at all.
• Some of the drugs used to control allergies MAY then lead to other problems down the road.  This is why that "allergy shot" needs to have a veterinarian's consent prior to administration.

Why we recommend a yearly rabies vaccines

I'm not sure if it's the lean financial times or concern for over-vaccination, but I feel like an increasing number of cat owners have been debating the benefits of having their pet receive a rabies vaccination.  I'd like to explain why I vaccinate my own pets and why I recommend every pet owner to do the same. 

I would agree that the likelihood of someones indoor cat being exposed to rabies is extremely low, but the fact remains that throughout the year, rabid animals are identified in the Houston area.  To my recollection, we've have one rabid horse recognized within the few months, and at least 3 skunks as well during 2011.  Of course, this is nothing to say of the bat population in Houston.  My perspective is that, even though the likelihood of rabies exposure remains low at this time, the consequence of getting rabies is so horrible that it's irresponsible not to protect yourself and your pets.

Rabies leads to brain inflammation and death.  If your pet were to get bitten by a rabid animal, and it doesn't have protection from the vaccine, you are going to lose your pet AND possibly put your own life at risk.  It's just not worth it.

So let's say you like to live dangerously - ask yourself one other question.  If for some unfortunate reason your pet were to bite anyone, would you be OK having your pet killed and tested for rabies?  The health of any human is always going to be held as paramount to the health of your pet.  If you were to have a house guest that gets bitten by your unvaccinated cat, that house guest's physician would likely ask for your cat to be euthanized so that the brain may be tested for rabies.  If your cat is current on the rabies vaccination, all that would be needed is 10 days of quarantine and observation.

As far as vaccinations go, the rabies vaccine is one of the most highly regarded in terms of effectiveness.  In terms of safety, most of the rabies vaccines tend to be extremely safe.  However, there are some vaccine variants can carry a slightly higher risk than others.  When a veterinary facility is purchasing vaccine, there are actually options to consider in regards to brand, cost, and components.  It is worth inquiring what rabies vaccines your cat will receive.  Many years ago, I was quite excited to know that the city of Houston would allow for three year rabies vaccines to be administered as I felt that it would be definitely better to give vaccine less often.  However, discouraging data exists suggesting slightly higher risk of three year rabies vaccinations in some cats.

I understand that in lean times budgets need to be re-evaluated.  Let's recognize that this is one area not to fool around with.

An invoice is not a medical record

Last week a stranger screamed in exaltation over the phone when I responded that, yes, we do board cats which need therapy such as subcutaneous fluids.  Apparently she had a plane to catch in 2 hours and her primary clinic doesn't do such a thing.  I explained that I had two conditions.  First, I must be allowed to assess the cat when it gets to our hospital so that I can be certain we won't have any surprises during boarding such as a horrid parasitism or difficult to control issues like unrelenting vomiting.  Second, I must be allowed to review the cat's medical record so that I can understand what sort of challenges the cat has faced in the past and anticipate any curve balls the cat may throw my way during the stay. 

She was happy to consent to the first, and assured me that she had in her possession the second.  Unfortunately, what walked in the door 20 minutes later was not a medical record.

To all of you cat lovers who keep a thick file at home with all of your invoices, I say good for you.  Unfortunately, that manila folder offers a veterinarian a limited glimpse into the cat's history.  Sure we can see when a vaccine was given, but what brand was it and where was it administered? I can see that blood work was run, but what were the values?  I can read that a medication was dispensed, but what was the dosing?

A complete medical record is going to give a comprehensive history of everything that your cat has received.  It provides the raw data that will allow a second opinion to come to its own conclusions.  After eight years, I have been told countless times that I was meeting with a cat who suffered true bacterial urinary infections, but reviewing the record confirmed my suspicions that an antibiotic was truly not what the cat needed for comfort.  It's going to tell me if a cat's heart rate typically falls around one value, so that when I hear that it's different than usual, there may be a problem.  By seeing the weight consistently fall around 11 pounds, I know something is up when our scale shows 9 pounds. 

I'm not saying you should toss those invoices, but understand their limitations.

A note on cat bites...

Every once in a while I will be surprised when a client asks me whether they should be concerned that their cat just sunk teeth deep into their arm.  Apparently they didn't have parents like mine. 

We have a small farm in Shiner, TX.  Story goes that there was this unfortunate fellow in Shiner 25 years ago that had some misfortune involving a fish hook, a cat, and his upper lip.  I don't remember the details, but horrible things ensued.  I seem to think he died.  I just know that I was really really freaked out, and that's how I learned to fear all the nasty stuff in cat mouths.  Due to this, I've always tried my best to play it safe around those teeth.

In retrospect, my understanding may have been influenced by my being a child and my fathers tendency for exaggeration...but an important lesson was passed on.  As I was able to escape the fear of my father's tales, I came to understand that nasty bacteria tends to live in feline mouths through my studies at vet school.  Cat bites can be bad!  Really bad.  I've known of colleagues to be hospitalized for days because of a bad bite.  A few of our clients have had surgeries on their hands because of a bite. 

Hospitalization...  Surgery... 

Bad, bad, bad.

I don't want to drum up fear about the cats we live with, but we need to respect some things as well.  Cat bites can be really nasty, and if you have broken skin because of an accident with any cat, don't take a chance and consult your physician.