November 25, 2008 Dear Provider: The following changes will go into effect December 1, 2008, regarding our Formulary coverage. Please take a moment to familiarize yourself and staff to the amendments. Additions: none Deletions: Beta-blockers —Blocarden (timolol) Alpha-blockers —Wytensin (guanabenz) Ophthalmics —Iopidine (apraclonidine), Isopto-Carbachol (carbachol), Pho
Millions of americans suffer from one form or another of arthritisCats on Cal Newsletter, Volume 9, December 2007 256 U.S. Route One, Scarborough ME 04074 – (207) 883-7000 Inflammatory Bowel Disease: Simplifying a Complex Disease
Do you frequently* come home to find vomit on your The first step is to perform fresh fecal exams to dining room rug? Does your feline companion check for parasitic and bacterial agents. The next occasionally defecate outside the box? Have you ever step will likely be an analysis of your cat’s blood noticed blood or soft stool in the litter pan? Does your and urine to check for illnesses such as feline cat have a normal or increased appetite yet she is leukemia virus, feline immunodeficiency virus, losing weight? These are all early signs of a very hyperthyroidism, or liver and kidney disease. In common disease called IBD or Inflammatory Bowel order to rule out a food allergy, your cat may be Disease. As the name implies, IBD can involve the placed on an elimination diet. The results of small or large bowel, but in most cases the stomach is these first few steps often indicate the need for primarily affected. The disease can extend out to abdominal radiographs and/or ultrasound. involve the liver and pancreas as well. Although cats of Finally, the most definitive of the diagnostic any age can be affected, middle-aged or older cats are tests is the microscopic examination of tiny more susceptible. The sooner IBD is diagnosed, the pieces of the intestinal or stomach lining. easier it is to treat and the better the long-term A tissue sample (biopsy) has traditionally been taken through a small incision in the abdomen. Nowadays, we commonly slide an endoscope What are the causes?
through the cat’s mouth or rectum in order to collect the necessary biopsy. Both of these latter Veterinarians do not know for sure what causes the procedures are the only ones which require disorder. They suspect that the problem is triggered general anesthesia. Cats with IBD are not known when an animal’s immune system becomes to have any greater risk for anesthesia. Thus a hypersensitive to an antigen. Two different responses proper diagnosis can be reached without worry. could be happening. Either the body could be over- reacting to a foreign substance such as a virus, bacteria How is Treatment Achieved?
or worms, or the immune system may be having an inappropriate reaction to a normal substance such as food or fur. When the immune system is mobilized, it medical therapy will successfully manage IBD sends its warrior cells (white blood cells) to do battle. in most cats. Because there is no single best This causes inflammation in the tissue surrounding the treatment, your cat’s doctor may need to try digestive system. It is also believed that if the intestinal several different combinations in order to lining is damaged, then the antigens can penetrate determine the best therapy for your cat. deeply and cause an even stronger immune response. There does not appear to be a single type or cause of Dietary Management
IBD. A host of factors are implicated, and these can Sensitivity to food antigens contributes to the inflammation in some cats, so a change of diet
How is IBD Diagnosed?
often provides symptomatic relief. A bland diet alone may control the vomiting or diarrhea, but Because of its various causes, IBD is not simply carbohydrate source that is brand new to the cat. diagnosed. There is no one IBD test, and the most These diets (termed hypoallergenic) are hard to common signs - chronic vomiting and/or diarrhea - can find over the counter, but our office carries a signal many different disorders. The only way to variety of flavors. The newest offering is a properly diagnosis IBD is by ruling out other diseases. formula called Z/D. This product uses the same It is a diagnosis of “exclusion” which involves many ingredients most cats are fed, but the proteins are steps. We will do our best to guide you through these altered in such a way that they no longer trigger pathways to a comfortable place for you and your cat. an immune reaction. In rare cases, the addition of dietary fiber is the best treatment for IBD. → Cats on Cal Newsletter, Volume 9, December 2007 256 U.S. Route One, Scarborough ME 04074 – (207) 883-7000 Inflammatory Bowel Disease: Simplifying a Complex Disease
bitter taste and thus must be disguised or given in a gel capsule to avoid any frothing at the It may take several weeks or longer for felines to improve after a diet change. For those patients with Sulfasalazine is the antibiotic of choice if large
severe or worsening symptoms, such as significant bowel inflammation (colitis) is the predominant weight loss, simultaneous medical treatment is truly complaint. Other antibiotics such as amoxicillin, indicated. A wide variety of drugs can be considered to treat IBD, and given the prevalence of this disease, occasionally prescribed. None of these require many more are under development. Some of the factors which play into the choice of medication include the severity of the symptoms, how often the symptoms occur and the cat’s overall condition i.e. the presence of any other underlying diseases. Often, two or more A wide variety of other classifications of drugs medications need to be given. Here are a few can be used for IBD. Some of these include commonly used medications for consideration. immunosuppressive drugs such as Leukeran ™
and cyclosporine, antispasmodics or anti -
Corticosteroids are commonly used to treat IBD. These hypermotility drugs such as metoclopramide,
and antacids such as famotidine (Pepcid™).
immunosuppressive properties with relatively few side effects in cats. Additionally, corticosteroids may themselves and fellow cats. Since hair is not stimulate the appetite and enhance intestinal water digestible, it could easily be a source of chronic absorption thus resulting in more trips to the litter box. irritation to the stomach or intestines. Frequent Two forms are commonly used. Prednisolone has
brushing and the use of oral hairball medication been used for years. It can be given as a pill, liquid or (laxaire™ and laxatone ™) are recommended
trans-dermal (across the skin) ointment. The newest for cats with IBD, especially if they have a corticosteroid, budesonide, comes from human
history of vomiting or passing many hairballs. medicine. It has the advantage that it is presumed not to be absorbed systemically, thus causing fewer side What is the Prognosis for Cats
effects. This drug also can come as a pill or liquid. with IBD?
Both of these medications require a urine and blood test twice yearly for monitoring of possible side effects. It is rarely possible to cure inflammatory bowel disease, but most cases can be satisfactorily Antibiotics can be help helpful when the side effects of steroids are too strong or when they have failed to management. Relapses can occur if the treatment adequately control the disease. Metronidazole therapy
regimen is not followed completely. If IBD is the most commonly prescribed antibiotic because it progresses too long without intervention the also has some anti-inflammatory properties. Side most common result is cancer. IBD is not a effects can involve the blood and are rare but are disease your veterinarian can diagnose and completely reversible if caught early. For this reason, resolve with only one visit. The good news is regular drug monitoring is required when the patient is that it can be treated with patience. IBD cats can on this drug. Tylosin is an antibiotic borrowed from
large animal medicine. It has not been officially approved for use in cats, but it has been used in cats for News Flash: Update on HTD
decades with no reported side effects. Although this Researchers believe that they have found the inexpensive drug does not require any blood cause of hyperthyroid disease. It is a common monitoring, both it and metronidazole have a very flame retardant placed on household rugs and furniture as well as our clothing. It has leached Cats on Cal Newsletter, Volume 9, December 2007 256 U.S. Route One, Scarborough ME 04074 – (207) 883-7000 Inflammatory Bowel Disease: Simplifying a Complex Disease
into the water and thus the food chain. This data explains the high correlation of this disease with some canned fish foods, as well as the shared incident rate we have with our feline friends.
INDUSTRIE-INFO 11/2009 1. Akkus mit zehnfacher Speicherkapazität geplant Nutzung von Sauerstoff als Reagenz als Schlüssel zum Erfolg Ein von der Universität St. Andrews (http://www.st-andrews.ac.uk) entwickelter Ansatz verspricht im Falle von Marktreife eine Verzehnfachung der Speicherkapazität von Lithium-Ionen-Akkus. Das vom UK Engineering and Physical Science Council (http://