Pain management is central to veterinary practice. As animals cannot verbalize their suffering, recognizing the signs of pain requires great attention both from the pet owner and the veterinarian. Managing the pain requires team based continuous care to anticipate, intervene and evaluate the pet’s response on an individual basis. Cats in pain are among the most difficult species to deal with for the following reasons:

• Diagnosing is difficult because they are very good at hiding their symptoms
• Treating is even more difficult because they frequently refuse most forms of medication.
• Finding the right choice of treatment is limited by the lack of approved drugs for feline patients with chronic pain.

Pixie is an eleven year old female cat brought to the veterinary office for some changes in her behavior over the last couple of months. Otherwise known as healthy, active and playful – Pixie started getting irritated whenever she was touched; she would also avoid playing with hard toys. Upon careful examination by the owner, it was noticed that she tends to retract her right foreleg when handled. The veterinarian’s gentle and thorough physical examination, an X-ray and a very detailed questionnaire lead to a diagnosis of degenerative joint disease (DJD)- more specifically – osteoarthritis of three joints: both hind knees and the right front elbow. Before deciding on the treatment plan, the veterinarian requests blood work for kidney and liver function to make sure that Pixie will be able to tolerate the needed long-term medication. After receiving the blood work results, the veterinarian decides on the treatment plan.

A long and detailed counseling session with Pixie’s owner takes place. The findings and the therapeutic plan are discussed at length:

• Adjustments in Pixie’s living environment must be made to facilitate for more comfortable mobility.
• Types of activities appropriate for Pixie’s condition are recommended.
• Advice on supplements and diet to help with osteoarthritis is given.
• The type of medication prescribed is clearly explained. The owner is informed about the reason for the selected medication, the expected outcome, the possible side effects, what to watch for and the importance of follow up visits.
• Meloxicam is prescribed in oral suspension with Pixie’s flavor- chicken, in a strength precisely calculated based on Pixie’s weight. The owner is advised to fill the prescription from a compounding pharmacy that specializes in preparing veterinary medications.

Case discussion: because of the reasons mentioned earlier, it appears that, the incidence of chronic pain due to DJD in cats is much higher than in was thought. Once properly diagnosed, careful consideration must be taken when planning the treatment. Despite the fact that NSAIDS are the drugs of choice for this condition for most species, it is not the same for cats due to susceptibility for toxicosis, particularly from long-term treatment.

The veterinarian prescribed Meloxicam – an NSAID approved for use in cats to treat postoperative pain and inflammation but only as a single 0.3-mg/kg dose administered subcutaneously before surgery. Many recent studies demonstrated that oral meloxicam in low strengths of 0.01-0.03mg/kg once daily can be administered safely and successfully for long-term in cats with osteoarthritis. Routine follow up for kidney and liver function is a must. In our case, Pixie was prescribed meloxicam as an oral suspension with her favorite flavor, to make it easier for the owner to administer it. The goal for the veterinarian and the client is to improve Pixie’s quality of life. Considering the circumstances, it is easy to see that treatment possibilities with commercially available medications are very limited. That is why personalized care is highly relevant and veterinary compounded medication is a critical component of it. When it’s about cats and their treatment possibilities – most medications must be compounded, because most medications are off-label use of drugs approved for human or other animal use. Thus, having a good working relationship with a reliable compounding pharmacy is a necessity for any caring and successful veterinarian.

If you have not selected a compounding pharmacy yet, now is the time to do so. Select HALDEY Pharmaceutical Compounding as your preferred choice in helping your patients and clients with customized medication. Talk to one of our experienced pharmacists for an assessment of your practice’s needs.