|
PART
II - HEALTHCARE
1. Shelter Healthcare
Our goal is to
provide the highest quality of overall care that is
possible. Accomplishing this task within our limitations as a non-profit
primarily voluntary organization requires vigilance and resourcefulness.
Attention to each individual cat and to the small details of
everyday life in the shelter have proven themselves to greatly aid in this
process. Learning to recognize all of the factors that impact upon the
health and well being of all of our resident felines is an essential
component.
Consciously and carefully evaluating the potential consequences and
impact of each chosen action on both the immediate situation and overall
picture is absolutely necessary at all times. Ultimately the guiding
principle to be followed without exception is: "To do no harm."
2. Veterinary Care and Resources
Primary responsibility
for the comprehensive care and well being of
our feline residents belongs to your organization. Veterinary care may be
provided by multiple community Veterinarians.
Your long-term good relationships with Veterinarians is absolutely
essential to your success. Each of these individual relationships must be
respected and maintained in order for your organization to provide the
vital community service that you have chosen to undertake.
Maintaining these relationships is the responsibility of your staff
and leadership. These vital relationships must not be jeopardized or
compromised.
Your Veterinarians and their staff provide skilled professional
services and are among your most valuable resources. They must be accessed
wisely, neither failing to refer to them for guidance when it is important
to do so, nor abusing their generosity by unnecessarily impacting upon
their valuable time.
3. Feline Healthcare in the Multiple Cat Facility
To compare the
care of companion cats in one's home with the
large-scale maintenance of health in a shelter would be an inappropriate
and invalid comparison. Factors influencing the well being of individuals
and the larger group of residents are present in the shelter that would not
be found in any home situation.
Crowding occurs at a rate that is incomparable with any home. The
nature of this situation predisposes shelter residents to development of
illness. As a result of a large number of felines residing in confined
quarters the concentration of microorganisms is abnormally high, which
increases every resident's risk of exposure to illness.
Daily sanitation practices may be inconsistent as a result of
varying levels of staffing.
Pre-existing conditions are present in a large number of residents
which can increase the risk of disease exposure to all of the cats and
leaves the affected cats more susceptible to any communicable disease.
A wide range of ages are present. The youngest and the oldest are
at highest risk of disease development.
Varying nutritional statuses among our residents leaves many
individuals more vulnerable to disease processes.
Adequate daily exercise is not always available to every individual
and the need for confinement in small cages for differing periods of time
leaves many in less than ideal overall condition.
4. Stress
In recent years, stress has come to be recognized as a significant
factor influencing the ability of living beings to function optimally.
Sources of stress are both internal and external. Stress can be
physical, psychological, or emotional. Environmental stress occurs. All
change is stressful. There are positive and negative stresses. All
stress, without regard to the source, has a physical impact on biological
processes, which is biochemically induced and has multiple and varied
effects on physical and psychological states. The ability of each
individual and of the group to adapt to stress is what determines the
ultimate result of the stress, in the short term and the long term.
Some significant stressors that we can identify in the shelter
environment include: multiple caretakers, changing feline population
levels, altering cage locations, and changes in daily routines. New
organisms are regularly introduced, diet and activity levels are altered,
individual attention is inconsistent, extremes of ambient temperature occur
periodically. As much consistency as you try to provide in this setting,
these on-going changes are somewhat unavoidable.
The number of residents concentrated in a small space is an
important factor as it results in a certain baseline or ambient stress
level for our cats because felines, by nature, do not live confined in
small spaces in large groups. Each individual in the group is sensitive to
this factor to some degree.
Other factors which cause stress to some individuals can include
acute, chronic or underlying illness, recent vaccination, lack of
vaccination, surgery, poor nutritional status, age, history, and whatever
individual circumstances caused our residents to require shelter placement.
Behavior changes and illness are common effects of stress,
biologically. The healthiest cats are the best able to adapt. If there
are any problems at all in physical or psychological state, the ability to
resist infection, the ability to heal, and the ability to cope
psychologically are reduced.
Therefore, providing consistency in a clean, healthy environment
and the most humane, high quality care that we are able is our cats best
chance to be happy, healthy, well-adjusted individuals ready for adoption
into permanent homes with loving families.
5. Health Maintenance
Prevention of disease
is a priority in the shelter, utilizing a
team approach, all staff, volunteers, and the organizational leadership
need to make a concerted effort to provide the best possible living
conditions for our felines. Such efforts are specifically directed at
minimizing stress factors, recognizing warning signs, and implementing
effective interventions to facilitate resolution of recognized issues.
Specific healthcare interventions include preventative measures
such as those included in our basic medical program with the Veterinary
exam, immunization, spay or neuter (S/N), elimination of parasites and
appropriate follow-up for recognized problems.
The efforts of a cohesive team provide both support to an effective
healthcare and maintenance program and maximize reduction of identified
environmental stressors. The team is able to provide specific support in a
variety of ways. These include controlling our population or census level
to avoid overcrowding, adequate staffing to provide improved sanitation,
maximum individual attention to each resident, consistent, thorough daily
routines, and consistent vigilant monitoring.
6. Monitoring
Daily observations
of each resident include appetite, bowel and
bladder habits, and monitoring for the presence of specific symptoms of
illness. Any specific problems or deviations from normal patterns should
be reported through the shelter supervisor to healthcare staff.
When specific illnesses or other health concerns occur, any
important monitoring needs should be posted on the cat's cage and shelter
staff notified of the need for additional specific monitoring.
7. Assessment
Healthcare staff
assess each situation individually and follow the
cat's progress on an ongoing basis. Frequently encountered illnesses,
minor injuries, and non-emergency health problems are handled by shelter
healthcare and regular shelter staff. Serious problems, worsening
conditions or other potentially more complicated medical issues are always
referred to our professional Veterinarian consultants in the community.
8. Basic Routine Healthcare
1. Health Record: The Health Record is maintained throughout
the cat's stay in the shelter. It is started upon intake and includes:
cat's name, intake date, Veterinarian ID #, shelter ID #, age or estimate
and description; vaccinations received and due dates for boosters; FeLV/FIV
test date and results; date of S/N surgery; worming dates, and any other
additional health information. The Health Record is filed in the shelter
and they are updated and maintained by shelter healthcare staff and
Veterinarians. The Health Record always accompanies the cat on Veterinary
visits. After adoption, a copy is filed with Adoption Records. Please
refer to Part I for additional information. All health related information
is documented on the Health Record.
2. Veterinary Examination
3. FeLV/FIV Testing,
also called Combo Test. Please note that
in the event of a positive test for either FeLV or FIV, the cat cannot be
accommodated in our shelter at this time. If there is any possibility of
alternative placement every effort should be made to provide the cat with
this placement. If there is no alternative only, the cat will be humanely
euthanized. When this is necessary, prior to the procedure the cat should
be made as comfortable as possible and provided with tasty food, treats or
catnip, and lots of TLC. Healthcare staff or shelter staff may wish to
accompany the cat for the procedure. If surrenderee wishes to be informed,
this should be done as gently as possible.
Prior to testing, newly admitted cats must not be allowed any
contact with shelter residents under any circumstances.
4. Spay or Neuter Surgery
5. Vaccinations. Please note that vaccines should never be
administered in the shelter unless a Veterinarian is present in the
building, as there is the possibility of allergic reaction, which can be
life-threatening. No more than two vaccines should be given on any day,
except under very special circumstances. The cat's immune system is
temporarily compromised following vaccination, leaving them more vulnerable
to any opportunistic pathogen present.
a) FVRCP, also called "feline distemper" protects
against Panleukopenia and some strains of common viruses that can cause
various respiratory infections. See Part I.
b) Rabies, given only by Veterinarians by law, is a
legal requirement for all cats in most states including Massachusetts. It
must be kept current and after two subsequent annual vaccinations can be
given in three-year increments.
c) FeLV offers some protection from the Feline
Leukemia Virus. It is recommended for all cats who go outdoors and cats in
multiple cat situations such as our shelter. Due to the possibility of
this vaccine increasing a cat's risk of vaccination site Fibrosarcoma, it
is given subcutaneously in the left leg. If both FVRCP and Rabies are
given to the cat on admission, the FeLV vaccination should be delayed by at
least one week to allow for recovery by the cat's immune system. A second
dose is required, 21-28 days after the initial dose in order to provide
protection. After each cat has received both doses of the FeLV vaccine,
they are allowed to freely socialize with the other fully vaccinated
shelter residents.
d) FIP is a controversial vaccine recommended for cats
in large multiple cat situations, such as the shelter. It is given to most
of our longer term residents, as the disease Feline Infections Peritonitis
is endemic in this area. It is administered intranasally (IN) and is very
irritating to nasal tissues, therefore, it is never given prior to one full
week after the IO/IN form of the FVRCP vaccine. The FIP vaccine can be
delayed any time there are any cats currently exhibiting URI symptoms in
the shelter. If the FIP vaccine is given, it requires a booster dose 21-28
days after the initial dose. Cats who have not been vaccinated with the
FIP vaccine may socialize with others.
Prior to administering any vaccine, the product package information
should be reviewed and well understood. Vaccines can be given only by
trained individuals. Safe practice standards must be utilized.
Sick cats or any cats with fevers should not be vaccinated until
they have fully recovered. If any doubt exists, always consult our
Veterinarians.
6. Worming. New cats, cats with obvious worms, and cats who
have had worms detected by fecal examination receive worming medications.
Drontal is used most often for new cats as it is effective against several
different varieties of worms. Read and follow label directions. Many
Veterinarians recommend a second dose to be given two weeks after the
initial dose.
Strongid-T liquid (generic form) can be used to treat roundworms at
1 ml. per 10 lb. body weight. Repeat this dose 10-14 days following
initial dose.
Droncit tablets are available for tapeworm. Follow label directions.
Worms or internal parasites are serious threats to overall good
health and should always be treated.
9. Feline Upper Respiratory Infection
(URI)
URI, part of the
Feline Viral Respiratory Disease Complex, is a
common occurrence in the shelter. URI is generally a viral infection,
although there can be other causes. In a shelter situation, there are many
factors that predispose cats to URI by increasing their susceptibility to
infection. These factors can include stress, poor nutrition, crowding,
hygiene or sanitation problems, age, pre-existing illnesses and vaccination
status. URI is a highly contagious process.
The importance of ongoing observation and monitoring our feline
residents for signs and symptoms of URI cannot be stressed enough. Once
URI is suspected, the cat showing signs of this illness needs to be moved
into the Sick Room as soon as possible to minimize the risk of other cats
being exposed. In healthy cats living in a home, URI is not usually
considered to be a potentially life-threatening illness. In stressed
shelter cats, who may have other problems as well, URI can be deadly, as
the risk of serious complications is greatly increased.
A. Signs and Symptoms
The signs and symptoms of URI are determined by the specific
structures involved in the infection, which can include the eyes, nose,
mouth, throat, and upper airway. The most common symptoms are sneezing
with nasal congestion and discharge, indicating that the nose is infected,
inflamed, and irritated. The nasal discharge and "sneeze residue"
contain
infectious material, which is also discharged into the air as the cat
sneezes. Eye drainage is another common symptom that can occur with URI,
usually indicating Conjunctivitis. (See separate section on
Conjunctivitis.) Other signs and symptoms or URI can include: sores on
the nose or mouth, coughing, mouth breathing, fever, depressed appetite,
and changes in behavior such as irritability or lethargy. These signs and
symptoms can range from mild and self-limited to severe and life
threatening, and many complications can occur.
Sneezing: At times, a cat may simply sneeze. In the shelter there
are a number of respiratory irritants that can be in the air in varying
amounts depending upon activity level. These include dust from litter, cat
hair, and dander. Strong odors such as bleach or disinfectants being used
to clean the cages, floors or laundry can also act as irritants to
sensitive individuals. Simple non-productive sneezing should be assessed
in the context in which it occurs in order to reduce the risk of exposing
healthy cats with irritated noses in the main room to sick cats with
communicable illnesses in the sick room. Vaccines administered nasally can
also irritate noses without causing illness. In some situations a cat with
sneezing as their only symptom should simply be monitored for further
developments. Thorough assessment, careful monitoring and experienced
judgement of the situation are vital.
B. Mild URI
Some cats will develop mild sneezing, with a small mount of clear,
thin, watery nasal discharge. As long as there is no fever and there are
no other symptoms, these cats can be moved to the sick room, provided with
clean water and tempting food to help maintain their appetites, and closely
monitored for any other symptoms to develop. Further treatment is not
needed as long as the cat is eating, drinking, acting well, and nothing
worse develops. When there has been no sneezing and the watery nasal
discharge has been fully resolved for at least four to five days, the cat
is no longer contagious and can be returned to the main room.
C. Complicated URI
In most cases a number of more serious symptoms accompany the
sneezing of URI. The third eyelids may come across the eyes. Frequent
productive sneezing with profuse nasal discharge and nasal congestion often
occurs. Signs and symptoms that require more aggressive treatment include:
fever above 102.5 degrees F, thick or discolored nasal discharge, bloody
or blood- tinged nasal discharge, severe nasal congestion with mouth
breathing, sores in/on the nose or mouth, wheezing, noisy respirations,
respiratory distress; diminished appetite or decreased water intake;
conjunctivitis; and severe lethargy. These can indicate more severe URI or
complications of URI and require thorough investigation and treatment.
D. Conjunctivitis
Inflammation of the membranes that cover the eyes and line the
eyelids (conjunctiva) can occur as part of the URI process or alone. Signs
of conjunctivitis include eye drainage and swelling of the membranes. It
can be mild and self-limiting or very severe, and complications can occur.
The causes of conjunctivitis include allergies, microorganisms such as
bacteria or viruses, irritants such as chemicals, and trauma. In the
shelter we most often see infectious conjunctivitis. Because the
conjunctiva is so delicate and sensitive, and the risk of severe
complications is so great, we treat all cases of this disease with
medication.
E. Treatment
Simple, mild URI: If occasional or intermittent, minor and
non-productive sneezing, and very mild nasal congestion with a small amount
of thin, clear watery nasal discharge are the only signs of URI in an
otherwise healthy adult cat, no medication is needed. The cat should be
moved to the sick room and monitored closely. If other signs or symptoms
appear, further intervention is then indicated.
Complicated or more severe URI: If other signs or symptoms
develop, antibiotic therapy should be initiated. Fever above 102.5 degrees
F, loss of appetite, decreased water consumption, and lethargic behavior as
well as obvious respiratory symptoms are indications for antibiotics.
Respiratory signs that indicate antibiotic therapy should be given include
an increase in nasal congestion, increased nasal discharge, thick or
discolored nasal discharge, bloody or blood-tinged nasal discharge, more
frequent sneezing and productive sneezing.
Although most cases of URI in the shelter are initially caused by
viruses, secondary bacterial infections often occur. Any time the mucus
membranes of the respiratory system are compromised by inflammation such as
occurs in even the most mild URI, the membranes are no longer effective
barriers to invasion by other microorganisms. This leaves the cat
vulnerable to more severe and complicated respiratory infections.
F. Antibiotics
Antibiotics are used to treat, and sometimes to help prevent,
bacterial infections. In general, they need to be given in adequate doses,
at appropriate intervals, for at least a full seven days. If antibiotics
are used improperly, in insufficient doses or less frequently than they
should be given, or for less than a full week, they can actually cause the
bacteria to become resistant and help make the infection more complicated.
On the other hand, antibiotics by definition are toxic substances that kill
living microorganisms, therefore they should not be used unnecessarily.
Antibiotics are powerful drugs and should be used with respect and caution.
Amoxicillin, commonly called Amoxi, is used in most cases of URI
because it covers a wide variety of bacteria, is relatively safe if used
properly, and is inexpensive if the generic form is used. This is the
first medication to use when signs and symptoms of more severe or
complicated URI develop. The most common side effect seen in the shelter
is diarrhea, which is usually of brief duration. We stock Amoxi in both
tablet form (50 mg. tabs and 100 mg. tabs) and liquid (50 mg./ml.). The
liquid comes as a powder which must be reconstituted by mixing with water
according to label directions, must be refrigerated after mixing and must
be used within two weeks (14 days). The dose for most adult cats is 50 mg.
and this dose should be given twice daily (b.i.d.), ideally at twelve-hour
intervals. Very large cats can receive 100 mg. (b.i.d.). The larger the
dose, the more likely diarrhea is to occur.
Cephalexin is also available in stock in tablet form (250 mg.).
The usual adult dose is _ tab. (125 mg.) b.i.d. This drug is more likely
to cause side effects such as vomiting or diarrhea and many cats have some
difficulty tolerating it.
An alternative drug in the same family is Cefa-Drops or Cefa-Tabs,
which is much more expensive. We can obtain them through our suppliers,
however, if needed.
Clavamox tablets and liquid are available. It is a form of
Amoxicillin which is augmented with a second drug to increase effectiveness
by making the bacteria less able to resist the Amoxicillin component. It
is more expensive than Amoxicillin, but it is usually well tolerated.
Ditrim is a combination antibiotic that must be obtained through
our Vets if prescribed. It is usually well tolerated, but an adequate
fluid intake is essential to prevent the potential complication of drug
crystals in the urine causing painful urination.
Baytril is a very potent antibiotic that we keep in stock for more
severe infections. It should never be used for minor infections as it is
much more potentially toxic than the other antibiotics available. It is
stocked in 5 mg. tabs and 22.5 mg. tabs. Baytril should be used on the
advise of our Vets and never for more than two weeks.
Antirobe (clindamycin) is an antibiotic that may be prescribed by
our Vets on rare occasions and can be obtained from our suppliers in
generic form. It can cause diarrhea, which can be severe.
Adverse reactions: Common side effects of all antibiotics are loss
of appetite, vomiting, and diarrhea. Many times the cat will take a day
or more to adjust to the drug and the problem will resolve on its own. The
appetite can be stimulated by offering tempting foods such as fish flavors
of canned food, Hill's A/D, or chicken baby food. Diarrhea can be helped,
to some extent, by adding a teaspoonful of plain yogurt with active
cultures to wet food twice daily, which helps to rebalance the normal flora
of the intestine that the antibiotic has disrupted. Rice baby cereal can
also be added to wet food for its binding effect. Vomiting can sometimes
be resolved by giving the medication on a full stomach. Subcutaneous
fluids should be given to treat any dehydration that occurs. Side effects
that do not respond to these measure should be reported to the Vet and
their advice requested on further actions to take.
Allergic reactions can also occur when using antibiotics. These
can be life threatening. Allergic reactions do not occur on the first dose
of a drug, but can occur on the second or any subsequent dose. Each
successive dose that is given after an allergic reaction occurs generally
has more severe consequences. You have no way of knowing if a cat has a
history of allergies to medications in most cases, therefore, all cats
receiving medications should be monitored closely. Early signs of allergic
reaction often include itching/scratching, hives or swelling. Difficulty
breathing, wheezing, or inability to breathe can also occur. Any suspected
allergic reaction needs to be reported to the Vet immediately, as emergency
treatment may be needed to save the cat's life.
G. Eye Ointments
Triple Antibiotic Eye Ointment (Bacitracin/Neomycin/Polymyxin),
"Triple," as it is often called, is a good choice for mild cases of
conjunctivitis, such as when the cat has clear eye drainage, in small
quantities, and only a small amount of inflammation in the conjunctiva.
Also, in cases of minor injury as we often see in cat fights, for
scratches near the eye, this can be used to help prevent infection. In
both cases the ointment is used twice daily.
Terramycin is the eye ointment we use most often in the shelter.
It is effective against Chlamydia, an organism that often causes moderately
severe cases of conjunctivitis. If there is a moderate to marked amount of
inflammation in the conjunctiva, and discolored eye drainage, Terramycin
should be the first choice, used twice daily.
Triple Antibiotic Eye Ointment with 1% Hydrocortisone is available
but used infrequently. This ointment helps to reduce inflammation and is
used when the conjunctiva is swollen noticeably, and the eye drainage is
clear. At times it may be used for a day or two to reduce swelling and
then changed to Terramycin or another drug, depending on the cat's response
and development of other symptoms. When there is a lot of swelling, it is
very uncomfortable for the cat. Reducing swelling can have many benefits,
as it will help the cat to feel generally better, which will promote a
better appetite, in turn promoting a more rapid recovery. It is used twice
daily.
Gentocin is available to use for more severe infections. It is
often used in cases where there is a poor response to Terramycin after
48-72 hours and by Vet recommendation. In general we avoid long-term use
of Gentocin because it is potentially toxic to the kidneys and can cause
hearing loss at high doses. Although very little is absorbed into the
system from the eye ointment, this is an issue to keep in mind, and never
continue Gentocin for more than two weeks except as directed by the Vet.
It is used twice daily or more often if recommended by the Vet.
Neo Predef is a very strong steroid anti-inflammatory and
antibiotic eye ointment. It should never be used without consulting the
Vet because, in certain conditions, it can cause severe and potentially
irreversible eye damage.
Unless otherwise prescribed by the Vet, all of these eye ointments
(ophthalmics) are administered twice daily, as our staffing patterns,
utilizing many volunteers, makes more frequent dosing unrealistic.
However, when it is essential to give medications more than twice daily, we
make every effort to do so, posting notices and writing reminders in the
staff and volunteer communication books.
H. Complications
Corneal Ulcer is a very serious potential complication of URI with
Conjunctivitis. Permanent eye damage or even blindness can occur. If the
cat shows profuse tearing, is rubbing their eyes with their paws, and seems
to have eye pain or sensitivity to light, suspect Corneal Ulcer. Test the
eyes in this case with Fluorescein to detect ulceration. If positive,
immediate Veterinary attention is needed. Whenever there is a severe
Conjunctivitis, always test for possible Corneal Ulcer.
Other serious eye infections can occur and require Veterinary
treatment. Signs to look for include swelling in or around the eye, fever
with conjunctivitis, profuse discolored eye drainage, clouding or
discoloration of the eye, or growth of abnormal tissue on the surface of
the eye.
Sinusitis can occur with URI. Signs include profuse thick
discolored nasal discharge, fever, and poor appetite. The cat should be
evaluated by our Veterinarians.
Pneumonia with fever, cough, poor appetite, lethargy, and
difficulty breathing is a frequent complication of URI, especially in a
stressed or debilitated cat. If there is any suspicion of Pneumonia, the
Vet should be consulted as soon as possible to evaluate the cat and
prescribe treatment. Hospitalization may be necessary.
Dehydration occurs easily any time a cat loses their appetite,
fails to consume adequate fluids, or can result from a fever. Any sick cat
needs to be assessed frequently for dehydration and fluids need to be
provided subcutaneously when this occurs.
Whenever a cat does not respond to supportive care and initial
antibiotic therapy within 48-72 hours, or their condition continues to
worsen, Veterinary advice should be obtained. Any time a cat appears to be
too sick to be maintained in the shelter, they can be hospitalized. When
seeking Veterinary advice, have the cat's health record available as well
as a full history of the present situation and the specific details of the
cat's condition.