Today's Veterinary Practice

SEP-OCT 2018

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CONTINUING EDUCATION todaysveterinarypractice.com SEPTEMBER/OCTOBER 2018 33 communicated to it by the mother through the placenta. 13 However, the CSRS can be sensitized by sufficiently harsh events at any time of life. DIAGNOSING PANDORA SYNDROME Many organ systems are represented in expression of Pandora syndrome ( TABLE 1 ), and the list is undoubtedly not comprehensive. Moreover, Pandora syndrome is only one possible cause of the disorders listed and may or may not be eventually added to the differential diagnostic criteria for that disorder. Provisional criteria for diagnosis of Pandora syndrome are presented in BOX 1 . The signs and sickness behaviors seem to wax and wane in response to environmental events more so in patients with than those without Pandora syndrome; however, this observation has not been adequately researched. The perception of threat associated with any serious chronic disease also has the potential to chronically activate the CSRS. In addition, one might consider whether the signs are disproportionately severe in relation to any pathology identified. For example, in humans, symptoms of ulcerative colitis are proportional to the severity of the pathology: whereas symptoms of irritable bowel syndrome may be severe in the absence of any identifiable bowel pathology. Of note, the diagnosis of Pandora syndrome is strengthened (perhaps confirmed) when all of the patient's signs subside in response to effective MEMO. 1 A tentative diagnosis of Pandora syndrome rests primarily on the results of a comprehensive history and physical examination. For cats with chronic recurrent problems, it may be worth your time to repeat the history and physical examination, saving the primary complaint for last. I have developed forms to guide the health history and household evaluation ( indoorpet.osu.edu ). 14 When the patient lives in a multicat household, I collect a health history for all cats in the household because these other cats also can have health problems that may be playing into the patient's problem, or they may reveal a source of conflict between cats. Whenever possible, I review the home environment in person, to evaluate the quality of resources for safe space; food and water availability, location, and management; litter box hygiene, location, and management; and opportunities for activity, play, and social contact. When the client completes the forms, I go over them with the client. I praise clients for everything they are doing right and offer coaching for areas that may benefit from modification. 14 Whether in person or from a completed form, I look for the following: Life history: Events in the cat's life history include early adverse experiences, such as being found as a stray or orphaned (especially if bottle fed) and exposure to serious trauma or environmental instability. Health history: Indications of multiple problems, especially if recurrences are frequent and associated with identifiable environmental stressors and fearful or anxious behavior. 14 Home environment: Evidence that the cat has a safe and secure resting space, ample resources located and managed appropriately, and the opportunity to interact on its own terms with the environment, including with people and other animals in the home. Although counterintuitive, some cats with Pandora syndrome (mostly males in my experience) exhibit more dog-like behavior, such as following their people around the house. MANAGING CATS WITH PANDORA SYNDROME Acute Care Decisions about medical care of cats with Pandora syndrome depend on the specific presenting problem(s). If the cat is hospitalized, careful consideration of the quality of the cage BOX 1 Diagnosing Pandora Syndrome Exclusion criteria Other causes of signs Incompatible history physical, lab, imaging, etc. Explainable peripheral pathology Inclusion criteria (Early) adverse experience Comorbidity, sickness behaviors Waxing and waning signs Global response to MEMO

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