Today's Veterinary Practice

SEP-OCT 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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Page 36 of 79

CONTINUING EDUCATION SEPTEMBER/OCTOBER 2018 35 ■ Low-stress handling. Use low-stress techniques to minimize activation of the cat's CSRS ( FIGURE 2 ). Indications that something may be wrong with caged cats include the cat's "resting" in the litter box with no sign that the cat has moved around the cage since the last cleaning or, the opposite, a cage that is in disarray. Sickness behaviors also are cause for concern. 3 These signs include vomiting, diarrhea or soft feces, no eliminations in 24 hours, urinating or defecating out of the litter box, anorexia or decreased appetite, lethargy, and/or not grooming. 3 You can determine that a cat feels threatened by observing changes in its physiology ( BOX 2 ) and behavior ( BOX 3 ), recognizing that the changes in one cat might differ from those of another cat that feels similarly threatened. Any housing situation or handling technique can be evaluated by assessing physiologic and behavioral parameters associated with perception of threat before and after applying MEMO, which usually becomes more effective after repeated uses. CHRONIC CARE Treating the Client Clients bring cats with Pandora syndrome to us to diagnose the cause of whatever signs concern them most. A diagnosis of Pandora syndrome means that we have identified an anxiopathy and, to the extent possible, have excluded other causes of the signs. In my experience, the most important consideration for a successful outcome for cats with Pandora syndrome is effective and empathic communication with the client. 14 When a complete evaluation of the cat leads to the conclusion that Pandora syndrome is likely (pending observation of responsiveness to MEMO), we explain to the client that although no cure is currently available, appropriate therapeutic and MEMO procedures can help. We tell clients that these procedures generally keep the cat's clinical signs to a minimum, increase its disease-free interval, and can usually be provided in collaboration with a trained technician. We also demonstrate empathy by listening carefully to the client's (often frustrated) story of the effects of having a cat with Pandora syndrome, provide a satisfactory explanation for the sources of the signs, express care and concern for the situation, and enhance the client's perception of control. Effective doctor-client interactions appear to enhance adherence to treatments and quality-of-life outcomes. 19 We can then prescribe any appropriate therapies and, when possible, introduce the client to the technician or other staff member trained to care for cats with Pandora syndrome. This person will coach the client on how to implement MEMO. The formality of this introduction demonstrates that we intend to sustain the partnership with the client through our technical support staff to gain control of the patient's clinical signs. Treating the Cat Diet and feeding management. Some diets are marketed for stressed cats, but their effectiveness at managing most manifestations of Pandora syndrome has yet to be evaluated, and their salutary effects, if any, seem modest. 20,21 Moreover, studies have shown that for many cats, Pandora syndrome can be effectively managed without any diet change. 1,3,22 For most cases, I recommend that clients choose whichever BOX 3 Behavioral parameters/body postures Immobility, hiding, cowering, or freezing behaviors Attempts to run away or avoid handlers Defensive aggression (hissing, growling, spitting, tail twitching, ear flicking, scratching, biting) Friendly approach to caregivers Purring, kneading, rubbing Interest in food Relaxed body postures Normal eliminations FIGURE 2. Minimal restraint of stressed cat. Courtesy AAFP

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