Title: How to manage risky drinkers in Primary Health Care Authors: Acknowledgements: This guide has been writen in accordance with the criteria of the PHEPA Training Programme on identification and brief interventions and the PHEPA Clinical Guidelines on identification and brief interventions. It is also inspired in ‘Helping patients who drink too much. A clinician’s guide. 2005 Edition’ fr
Microsoft word - print-friendly medicating feral kittens.docSome Helpful tips for MEDICATING FERAL KITTENS Printed with permission from www.urbancatleague.org written by Mike Phillips, L.V.T. With sickly feral kittens try to use your vets most effective but least invasive treatment available. Forcibly restraining kittens unnecessarily to medicate them can set back the taming process and sometimes make complete taming impossible. Along with any medical treatments remember to feed the most nutritious food possible. A healthy immune system can combat many ailments, but it needs premium quality food to feul the battle. Natural Balance, Petguard, Wellness, Nutro, Eukanuba are among the best for nutrition. Friskies and Wiskas are inferior, but the better of the grocery store brands. Stay away from grocery store brands when you have a sick cat. The moisture from wet food is much preferable to dry food. (Disclaimer: Keep a sick cat eating even if it only wants a less nutritious brand. Eating “something” is the most important thing.) Building a healthy immune response through a top quality diet can often heal a feral cat when you can’t handle her safely to medicate properly. Here are some of the simpler medical treatment options which don’t require stressful or traumatic restraint: FLEAS: When safe-handling is impossible, forget about a flea bath! CAPSTAR pills crushed in food are a safe and effective flea treatment for cats and kittens 4 weeks and older. A half pill is the safe dose for 4-8 week old kittens. CAPSTAR does not require a prescription and can be purchased online at any of the PetMeds-type websites, or even some pet supply stores. CAPSTAR kills fleas in 3-6 hours at which time the cat/kitten may be brought anywhere without fear of risking flea infestation if you dispose of the old infested bedding. The pills can be crushed and sprinkled onto a small amount of a tasty food. They have no unpleasant taste. CAPSTAR has no residual effect so the cat/kitten must not be re-exposed to fleas. It does not kill eggs on the cat so follow up with a long-acting topical treatment when you can handle the kittens safely. Advantage, Revolution, Frontline, etc. continue working for one month). IF you find you CAN handle the kittens in time, a bath with Dawn dish-washing detergent kills fleas on contact. Sometimes a flea comb dipped in the soapy water is enough to comb out a few fleas. Put a soapy ring around the neck and anus at the start to prevent the fleas from escaping into ears and you know where. REVOLUTION has the benefit of also treating ear-mites and roundworms(see below). EAR MITES: REVOLUTION requires a prescription but will effectively treat Ear-Mites; (it also treats fleas and roundworms at the same time). Briefly handling of the cat/kitten is necessary to squeeze a small amount of the REVOLUTION liquid onto the cat’s skin between the shoulder blades. This can be done at the time of a vet exam or after the Spay/Neuter surgery. Other EAR MITE treatments require fourteen days of twice daily ear drops with a refrigerated product like TRESADERM. This is stressful and traumatic for fearful kittens. Cold ear drops twice-a-day for two weeks is not a good recipe for taming. Some say REVOLUTION needs two treatments, but in the right dose, it has worked well for us every time. The vet can clean and treat the ears with Acarex or Ivermectin to kill the mites when the kittens get their Spay/Neuter surgery if you can’t treat before then. Ear mites are contagious and uncomfortable, but not life threatening. If you find you must wait for a vet visit to get them treated the kittens will be ok to wait a bit, but treat a.s.a.p. VIRAL INFECTIONS: Treating eye infections can be very difficult but must not be neglected. Scarring and loss of vision is common with untreated Herpes Virus eye infections (Herpes is the R in the FVRCP vaccination). Make sure you have the correct diagnosis since treating with the wrong eye medication can be useless or even harmful. Let the vet prescribe the eye med since you could do harm with the wrong one. For example: if the surface of the eye has been harmed, a steroid ointment could cause permanent damage. If you are required to use the standard tubes of eye ointment (Terramycin, Vetpolymicin, etc.) or drops, remember thata If the tip of the tube touches the eye, you may spread the virus to everyone else you treat with that tube. Ideally each patient has their own individual tube. If this is financially impossible, take your time and be extra careful. To undo the bad experience of being restrained and treated for the eye problem spend extra nurturing time with the kittens before and after treating the eyes with the proper eye ointment or drops. Terramycin ointment is said to be the most effective against Herpes however it also stings the most. If the eyes aren’t in too, too bad shape, the vet may agree that gentler drops and gentle cleaning may be enough rather than the irritating Terramycin. Antibiotics have no direct effect (read about Zithromax below) on viral infections like URI (Upper Respiratory Infection) but often vets will prescribe one to treat or prevent a secondary bacterial infection. This is usually easily mixed into food without handling the cat. Make sure you can follow the directions precisely or don’t treat the cat with ABs. Antibiotics are not a “hit or miss” medication to be played around with. Ask the vet if you’re not sure! Kittens with URI that are bouncing around and playing and most importantly eating normally, may not need an antibiotic at all. Zithromax (Azithromycin), has been found to be very effective for resolving kitten and adult Herpes eye infections. Although it is an antibiotic and we all know they can't cure viral infections, vets are documenting that an Azithromycin course of treatment often resolves Herpes eye infections. Azithromycin can be compounded with flavors and stirred into food, avoiding the need to restrain the animal to treat it. It can be ordered with a prescription from VetCentric.com and mailed to you if your vet or pharmacy doesn’t do compounding. The medicine itself is not perishable, so stick with the non-perishable flavorings. We use the "Roasted Chicken” and not the perishable "Tuna" which needs refrigeration. The success of this treatment for herpes is unexplained and "off-label" so your vet may not be aware of this seemingly miraculous if counter-intuitive treatment for Herpes eye infections. When eye ointment treatments are impossible, Azithromycin could save the day. It can also be used as the preventative treatment for a secondary bacterial infection. There is another drug Famciclovir which is sometimes used for a difficult viral or herpes eye infection. PARASITES: Most vets give STRONGID for ROUNDWORMS as a matter of course (must be repeated once 14-21 days after first treatment). This can easily be put in food and gobbled up without detection. Strongid is a very effective and safe medicine but will not resolve other parasites such as COCCIDIA or GIARDIA. These others are less frequently seen, but very common. Diarrhea can be very serious to kitten health and should not be neglected. An exact diagnosis can be difficult to get but if diarrhea persists, take a stool sample to your vet for testing. The test for Giardia is more expensive and not normally run as a matter of routine. Be sure to ask the vet if he thinks it is necessary and offer to pay the extra for the Giardia test. The routine treatment for Giardia is 10-14 days, twice per day of a very bitter drug called Metronidazol or Flagyl. It is impossible to disguise this drug in food and usually makes the most tame housecat impossible to pill after one taste. Ask for the caplets that are coated and NOT the dog size pill that breaks into powder when you dose it for cats. A MUCH better alternative for treating Giardia in the feral cat or kitten is PANACUR liquid suspension. Don’t use the powder, the liquid suspension is easier to mix in with food. It has a chalky taste that gives you a much better chance of sneaking it into food. It’s a once per day treatment for only 5 days which is much shorter than the bitter pill regimen. Whenever diarrhea is present, feed a high fiber cat food like W/D to physically push out as many of the parasites as possible. Adding a tablespoon of unspiced canned pumpkin to the food can add fiber to regular wet food. High fiber food may sometimes be enough to clear up a simple case of diarrhea but be ready to get a proper diagnosis and treat with meds if the diarrhea persists. RINGWORM: One of my professors told me, “It takes 21 days for Ringworm to heal if you treat it, and 3 weeks if you don’t treat it.” I found this to be true once treating two young feral kittens. One with sulfur dips and conifite lotion requiring repeated vet trips which terrified her. As a result, she was never comfortable being handled. Her sister was too feral for the vet techs to even handle for the treatments, and she healed on her own with good nutrition in the same amount of time. She is now a loving lap cat while her sister still hates being touched. One effective oral drug we’ve used, Itraconazole can be flavored at the Pharmacy and you can sneak it into the food for ferals. For years PROGRAM, a flea treatment, was being used to treat Ringworm but the recent vet literature says it doesn’t work at all. For hard to treat ferals, we recommend you target good nutrition to build a curative immune system response if a vet treatment is impossible. It does resolve in time. ANTIBIOTICS: There is an "off label" use for Cefovecin (Convenia™) which allows a one-time injection that provides 7-14 days of antibiotic treatment for cats. This means that a feral cat which is discovered to have an infected wound or needs teeth pulled at the time of TNR could get this one shot while still knocked-out for the neutering. This allows antibiotic treatment for many feral cats that previously went without antibiotics. It's termed "Off-label use" because Cefovecin (Convenia™), has only been tested and approved for treating dermatological problems but doctors have found that it works for many other things AND has the 7-14 days of residual effect. Studies have shown that the only side effects (rarely seen) may be some nausea for a couple days but don't last for the entire 7-14 days. If your vet doesn’t understand the challenges of taming and building the kitten’s trust, there are many other vets who do, and will work with you to get the kittens to optimal health without using treatment methods that undo your hard work toward socialization. Ask around for a recommendation from one of the many groups working with feral cats. In NYC get a referral at nycferalcat.org from the NYC Feral Cat Initiative. The kittens AND YOU, deserve all the help and understanding you can get!! Check the urbancatleague.org taming page for a printer-friendly version of this hand-out.
Current Perspective Coronary Heart Disease: Reducing The Risk A Worldwide View Gerd Assmann, FRCP; Rafael Carmena, MD; Paul Cullen, FRCPI; Jean-Charles Fruchart, PhD;Fabrizio Jossa, MD; Barry Lewis, FRCP; Mario Mancini, MD; Rodolfo Paoletti, MD;for the International Task Force for the Prevention of Coronary Heart DiseaseWorldwide, cardiovascular diseases are now the most risk increases