Pilling Cats

[~flower~]

http://www.catinfo.org/pillingcats.htm

Here is the relevant part of the page, entitled "A Very Interesting
Study" It is from a paper presented at the 2001   American College of Veterinary Internal Medicine Forum. (They do note at the end of the paper that the principles outlined also make good sense for dogs.)  This paper was submitted to one of the lesser-read journals so a lot of veterinarians may not have seen it.  This is extremely unfortunate for all cats and dogs.

[snip]

The following is a summary of a very interesting article that
appeared in a veterinary journal entitled Evaluation of the Passage
of Tablets and Capsules Through the Esophagus of the Cat. It is from
a paper presented at the 2001 American College of Veterinary
Internal Medicine Forum. (They do note at the end of the paper that
the principles outlined also make good sense for dogs.) This paper
was submitted to one of the lesser-read journals so a lot of
veterinarians may not have seen it. This is extremely unfortunate
for all cats and dogs.

Purpose of the study:
The goal of the study was to determine the length of time that it
took for pills or capsules to enter the stomach after 1) dry pilling
and 2) pilling and then giving a 6 cc water chaser immediately
following the administration of the pill or capsule - referred to as
a "wet swallow".

Study design:
30 cats were used. Fluoroscopy was used to evaluate the pill/capsule
passage at 30, 60, 90, 120, 180, 300 seconds.

Study results:
For the dry swallows:
No pills were in the stomach at 30 and 60 seconds. Only 6% of the
pills were in the stomach at 90 seconds. Only 13% of the pills were
in the stomach at 120 seconds. And at 5 minutes only 36% of the
pills were in the stomach.

For the wet swallows: (i.e., the pill was followed by 6 cc of water)
At 30 seconds, 90% of the pills were in the stomach. All pills were
in the stomach by 120 seconds.

The statistics were even worse for capsules when dry swallowed. By 5
minutes, only 16% of the capsules had made it to the stomach. 100%
of capsules followed by water chasers, were in the stomach by 60
seconds - faster than for pills probably due to the smoother surface
of a capsule versus a pill.

Commentary:
"This is an interesting study that has considerable practical
impact. Although veterinarians have a huge arsenal of medications and
treatments available to us, we still have a very poor understanding
of some of the most basic aspects of everyday practice. We routinely
prescribe oral medications in the form of tablets or capsules to
cats.

It has been our assumption that when it was possible for the owner
to actually give the pills or capsule to the cat, it would make it
into the stomach reasonably rapidly. It turns out that this is
inaccurate. After 5 minutes 84% of capsules and 64% of tablets are
still sitting in the esophagus. Similar results were published in
another study by JP Graham (American Journal of Veterinary Research
2000).

Practical outcome:
The main concern with this information is that if tablets and
capsules sit in the esophagus for a prolonged period of time, this
can cause damage to the tissues in this area. This damage can lead
to esophagitis, which can lead to nausea, vomiting and
megaesophagus. At times, the esophagus can also respond by
developing an ulcer or stricture. The latter is a very serious
complication requiring aggressive therapy, preferably with balloon
dilatation.

In addition, we probably have all had that uncomfortable feeling
when a tablet we have taken has gotten stuck on the way down. This
could be the cause of vomiting in some cats that are medicated. It
is quite frustrating to win the battle to get the pill or capsule
down a cat and then have it vomited up several minutes later.

Both this abstract as well as the study published by Graham et al.
clearly point to the need to administer either water or food after a
cat has been pilled with a tablet or a capsule. This will hasten the
movement into the stomach and cut down on the chances of the tablet
or capsule remaining in the esophagus for a prolonged period of
time. Although comparable studies have not been done in dogs, this
advice is sound in dogs, as well."
(End of quoted study)>>

[Vet]

http://www.catinfo.org/pillingcats.htm

Here is the relevant part of the page, entitled "A Very Interesting
Study" It is from a paper presented at the 2001   American College of Veterinary Internal Medicine Forum. (They do note at the end of the paper that the principles outlined also make good sense for dogs.)  This paper was submitted to one of the lesser-read journals so a lot of veterinarians may not have seen it.  This is extremely unfortunate for all cats and dogs.

[snip]

The following is a summary of a very interesting article that
appeared in a veterinary journal entitled Evaluation of the Passage
of Tablets and Capsules Through the Esophagus of the Cat. It is from
a paper presented at the 2001 American College of Veterinary
Internal Medicine Forum. (They do note at the end of the paper that
the principles outlined also make good sense for dogs.) This paper
was submitted to one of the lesser-read journals so a lot of
veterinarians may not have seen it. This is extremely unfortunate
for all cats and dogs.

Purpose of the study:
The goal of the study was to determine the length of time that it
took for pills or capsules to enter the stomach after 1) dry pilling
and 2) pilling and then giving a 6 cc water chaser immediately
following the administration of the pill or capsule - referred to as
a "wet swallow".

Study design:
30 cats were used. Fluoroscopy was used to evaluate the pill/capsule
passage at 30, 60, 90, 120, 180, 300 seconds.

Study results:
For the dry swallows:
No pills were in the stomach at 30 and 60 seconds. Only 6% of the
pills were in the stomach at 90 seconds. Only 13% of the pills were
in the stomach at 120 seconds. And at 5 minutes only 36% of the
pills were in the stomach.

For the wet swallows: (i.e., the pill was followed by 6 cc of water)
At 30 seconds, 90% of the pills were in the stomach. All pills were
in the stomach by 120 seconds.

The statistics were even worse for capsules when dry swallowed. By 5
minutes, only 16% of the capsules had made it to the stomach. 100%
of capsules followed by water chasers, were in the stomach by 60
seconds - faster than for pills probably due to the smoother surface
of a capsule versus a pill.

Commentary:
"This is an interesting study that has considerable practical
impact. Although veterinarians have a huge arsenal of medications and
treatments available to us, we still have a very poor understanding
of some of the most basic aspects of everyday practice. We routinely
prescribe oral medications in the form of tablets or capsules to
cats.

It has been our assumption that when it was possible for the owner
to actually give the pills or capsule to the cat, it would make it
into the stomach reasonably rapidly. It turns out that this is
inaccurate. After 5 minutes 84% of capsules and 64% of tablets are
still sitting in the esophagus. Similar results were published in
another study by JP Graham (American Journal of Veterinary Research
2000).

Practical outcome:
The main concern with this information is that if tablets and
capsules sit in the esophagus for a prolonged period of time, this
can cause damage to the tissues in this area. This damage can lead
to esophagitis, which can lead to nausea, vomiting and
megaesophagus. At times, the esophagus can also respond by
developing an ulcer or stricture. The latter is a very serious
complication requiring aggressive therapy, preferably with balloon
dilatation.

In addition, we probably have all had that uncomfortable feeling
when a tablet we have taken has gotten stuck on the way down. This
could be the cause of vomiting in some cats that are medicated. It
is quite frustrating to win the battle to get the pill or capsule
down a cat and then have it vomited up several minutes later.

Both this abstract as well as the study published by Graham et al.
clearly point to the need to administer either water or food after a
cat has been pilled with a tablet or a capsule. This will hasten the
movement into the stomach and cut down on the chances of the tablet
or capsule remaining in the esophagus for a prolonged period of
time. Although comparable studies have not been done in dogs, this
advice is sound in dogs, as well."
(End of quoted study)>>

You know, there is a reason this was published in a lesser read journal....   


First off, for Flower, considering I don't see domestic animals as patients as frequently as I used to, the majority of the medications I prescribe are in liquid form or they are compounded in liquid form.  Why?  Because its easier to medicate with thicker liquids (thus they are more likely to swallow and less likely to choke). 

The problem with this study is threefold.  First off, what was the technique of the person administering the medication?  Getting a cat or dog to swallow a pill or capsule is highly dependant on the technique of the individual giving the medication, the size of the medication, the surface structure of the medication, and the palatibility of the medication.  There is a big difference between placing the pill on the tip of the tongue and in the pharyngeal region.  I've encountered more than one animal where one person could not medicate it because of poor technique while a different person had no problems.  This variability automatically skews the statistics of this study. 

Second, just how did they evaluate the pill was actually in the stomach?   Any method of evaluation that I'm aware of---ie endoscopy, flouroscopy, indwelling scope all require anesthesia in some form.  This anesthesia runs a great risk of altering an animals ability to swallow normally.  I fail to see validity with this experiment based on that alone. 

Thirdly, there is no consideration for aspiration induced pneumonia as a result of squirting water in the animals mouth.  This is a high risk.  If you don't believe me, take a pissed off cat you've just given a pill to and try to get it to drink water out of a syringe or a dropper.   I've seen two cases of pneumonia in cats (one domestic, the other "wild) when I was in private practice from the owners squirting water in the cats mouth and the cat fighting back.   You cannot make a recommendation like that without considering that potential complication.  (by the way---I always swallow pills dry, be it vitamins, medications, etc--I don't know why, i just do).   


If there is a doubt about the pill going down, I recommend chasing it with a food treat, not water (this is the common recommendation from the practices I've worked in).   The reason is the animal will swallow with the food treat, passing the pill.  Second, it makes giving pills a positive experience for the animal.  Squirting water in their mouth has too much potential to induce further struggles for the animal to take a pill.  Giving them a "happy treat" keeps things positive and increases the potential for the animal to be less combative.  Finally it decreases the risk of aspiration pneumonia. 

[emn1964]

I thought this thread was about how to stack up cats, particularly after they are dead.  That is, how to pile up cats or piling cats.  I missed the other l in pilling.

[emn1964]

In all seriousness, though Vet's response brings up a good point.  Just because a study is published doesn't mean that it's conclusions are valid.  The supplement industry has been taking "studies" out of context and using them to peddle their snake oils for years.  And on the steroid board, people do it regularly to back up some claim of efficacy.  So, unless you have more than just a cursory knowledge of a&p, either of the animal or human variety, then be wary of relying on that study or of any claims based on the study.  I can't tell you how many times I've seen things taken out of context from a review or a lay person misinterpreting a technical term.

[~flower~]

Have you ever swallowed a pill and had it stay in your throat? I have.  It is not hard to believe that giving an animal a pill with nothing to flush it down with wouldn't result in the same thing happening.  I have swallowed capsules WITH liquid and had a 1/2 hour later some "powder" come back up my nose and throat when the pill dissolved.  Not very pleasant, and I would think depending on what the medication is it could be damaging to the throat.

 It can be a real pain in the ass to get a pill down a cat, or even a dog, so I think this study brings up a valid point to use a liquid form of medicine
whenever possible.

As an alternative to pilling, I strongly urge people to have their cat's medication made up into a flavored liquid compound for ease of administration.  That said, some people state that their cat is not good about swallowing liquids and these people prefer to use pills.

quoting Vet:

Getting a cat or dog to swallow a pill or capsule is highly dependant on the technique of the individual giving the medication, the size of the medication, the surface structure of the medication, and the palatibility of the medication.  There is a big difference between placing the pill on the tip of the tongue and in the pharyngeal region.  I've encountered more than one animal where one person could not medicate it because of poor technique while a different person had no problems.

  So you would agree with what I said?  How many lay people are going to be very good at getting a hissing, scratching, fighting cat to take a pill correctly?

  Seems like the point of using a liquid medicine if possible would benefit the animal and the person administering it.
 

[Vet]

Have you ever swallowed a pill and had it stay in your throat? I have.  It is not hard to believe that giving an animal a pill with nothing to flush it down with wouldn't result in the same thing happening.  I have swallowed capsules WITH liquid and had a 1/2 hour later some "powder" come back up my nose and throat when the pill dissolved.  Not very pleasant, and I would think depending on what the medication is it could be damaging to the throat.

 It can be a real pain in the ass to get a pill down a cat, or even a dog, so I think this study brings up a valid point to use a liquid form of medicine
whenever possible.

LOL.  No, like I said, I tend to swallow all pills dry.  I don't know why, I just do.  I also don't have problems burping them back up. 
 

quoting Vet:

  So you would agree with what I said?  How many lay people are going to be very good at getting a hissing, scratching, fighting cat to take a pill correctly?

  Seems like the point of using a liquid medicine if possible would benefit the animal and the person administering it.
 

There is a difference between liquid and the "thick" liquids that I talked about earlier.  Liquids the consistancy of water do have a risk of aspiration.   That has to be considered.  I personally prefer pastes, but they MUST be palitable. 

The real key is to evaluate the individual animal and provide a form of medication that allows delivery with minimal stress of the animal.  If thats liquid, then so be it.  If its paste or pill in peanut butter/cheeze or by injection, then those forms all need to be considered when prescribing appropriate medications for treatment of a given medical condition.  Unfortunately there are some medications that are only available in one form, so that has to be considered. 

[~flower~]

Palatable seems to be an individual preference in the animal kingdom. 

 I hear you on the aspiration issue though.  When I have had to dispense liquids or feedings I go in the side of the mouth and don't squeeze it in but slowly administer it. They will almost "chew" on the dispenser.   Depending on the animal you can wrap them up in a towel so just their head is sticking out, makes it easier when it is just one person trying to get it in them, and they aren't being crushed by you trying to hold them. 

[Vet]

Palatable seems to be an individual preference in the animal kingdom. 

 I hear you on the aspiration issue though.  When I have had to dispense liquids or feedings I go in the side of the mouth and don't squeeze it in but slowly administer it. They will almost "chew" on the dispenser.   Depending on the animal you can wrap them up in a towel so just their head is sticking out, makes it easier when it is just one person trying to get it in them, and they aren't being crushed by you trying to hold them. 

And also, like I said earlier, I really prefer chasing any sort of medication for a domestic species (be it dog, cat, horse, even some species of birds like the larger parrots) with a solid food treat.  That turns giving the medication into a positive experience for the animal and it guarantees that they swallow what you administer. 

[JediKnight]

Flower, nowadays they use liquid and dont pill cats very often, and when it's done, it is done with care. if someone is kind enough to give a cat medicine, they are looking out for it.

[Geo]

I usually just put on a pair of welders gloves and give my cat suppository's