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Feature March 2013 Issue

Hospitalizing Your Cat

Your cat may one day need more intensive care than your regular veterinarian can provide. Here’s some insight into how a veterinary teaching hospital works.

Having a sick or injured cat is very stressful, especially when the problem lies beyond the scope of your regular veterinarian. Add the need to hospitalize your pet and your anxiety level likely goes through the roof.

John Berg, DVM, surgical specialist at the Foster Hospital for Small Animals at Cummings School of Veterinary Medicine at Tufts University, acknowledges that anxiety. “Primary care veterinarians can handle the majority of diseases that cats get, so by definition, specialty hospitals have sicker patients and more concerned owners,” he says.

Dr. Berg offers reassurance to those who worry not only about their cats’ health, but also about their reaction to being away from home. “The overwhelming majority of animals take hospitalization right in stride,” he says. “The mystery is why it doesn’t bother them more.”

Putting pets at ease

Today’s veterinary hospitals also recognize the need to put both animals and their owners at ease. For example, the lobby at the Foster Hospital features separate sides for dogs and cats. There’s a good reason that cats might feel overwhelmed in many hospitals. According to Dr. Berg, cats are vastly outnumbered by dogs, which constitute the majority of hospital patients.

The separation of species extends to the hospital units themselves. Cats who are not sick enough to be sent to the Intensive Care Unit (ICU) stay in a separate ward — C ward— where they don’t encounter dogs. “Cats are inherently a lot less active and don’t need to go out on walks,” adds Dr. Berg. “They tend to be much calmer and just lie in their cages. If they do show signs of being anxious, we give them a place to hide like under a blanket, and generally, they feel a lot better.”

Of course, not all referral hospitals — hospitals to which a gen eral practice or family veterinarian sends clients whose pets need to see a specialist — are alike. The Foster Hospital is a teaching hospital, affiliated with Cummings School, and one of only 27 veterinary teaching hospitals in the United States. This not only means that upper-level veterinary students participate in the patient rounds, but also that a great variety of specialty departments are available, the better to prepare future specialists for their practices.

In fact, the number of veterinary specialists in private practice has doubled in the past decade, according to the American Animal Hospital Association. Thousands of board-certified veterinary specialists in North America practice in such fields as oncology, dermatology, internal medicine, surgery, neurology, cardiology, feline medicine and dentistry.

Many private referral hospitals offer most of the specialties available in teaching hospitals, affording interns and residents the opportunity to emergency and critical care. The clinics at which emergency medicine is practiced aren’t only for pets who are extremely ill and need around-the-clock treatment, however. They also serve patients whose health problems occur outside of regular veterinary hours.

Elizabeth Rozanski, DVM, who is board-certified in veterinary emergency and critical care medicine and heads Foster Hospital’s ICU, explains that bringing in a cat at an off-hour doesn’t necessarily mean an overnight stay is needed. “We always have someone on hand to do an evaluation,” she says, noting that, day or night, the choice of whether or not to admit the pet is ultimately the owner’s decision.

Making informed decisions

Dr. Rozanski emphasizes that the staff tries to provide sufficient data for an owner to make an informed decision. She gives the example of a cat who comes in with bad vomiting or diarrhea: “We might say, ‘He should stay in the hospital because he needs fluids. We’re worried that he could get weaker.’ Or we might tell an owner, ‘We’re not really sure why your cat is experiencing this and we need to find out.’ ”

Alternatively, Dr. Rozanski observes, “We might say, ‘Based on what we’re seeing right now, it’s likely your cat will get better on his own, but if you feel more comfortable leaving him here just to be sure, that’s fine, too.’ ”

Some owners prefer to take their cats home because they know they’ll be around to observe them closely. Others have work schedules that don’t permit careful scrutiny, however, so they prefer to have their cat’s progress monitored at the hospital.

Obviously, financial considerations also come into play, both in emergency and elective care decisions. “People shouldn’t feel guilty or embarrassed asking about costs and letting the specialist know expense is a factor when it comes to deciding about treatment,” says Dr. Berg. “Very often, there’s a middle ground of care.”

Typically, the emergency staff sees unexpected flare-ups of chronic health problems or injuries that occur outside the home, such as car accidents, but occasionally they encounter self-inflicted injuries. Dr. Rozanski cites the case of a three-year-old calico who came in with sewing thread wrapped around the tip of her tongue so tightly that it acted like a tourniquet.

“The owners had no idea how it happened,” Dr Rozanski says. “They came home to find the cat drooling and rubbing at her face.” The treatment, cutting off the thread, wasn’t complicated, but recovery was slow. The tongue remained black for a couple of days and the doctors thought they might have to amputate the tip. After three days, the circulation returned to normal.

“It was an odd case,” she recalls. “Cats usually either eat the string without a problem or have a foreign body create a problem within the intestines. Getting something just wrapped around the tongue is rare.”

As is characteristic at any round-the-clock facility, members of the Foster Hospital staff work in shifts. The hospital is busiest during the day, when the specialists see patients for examinations or for diagnostic procedures such as X-rays, perform surgeries and admit or discharge pets.

Round-the-clock care

Veterinary technicians are on hand throughout the night to read and record data that can be presented to the team of doctors the next morning — or, if need be, to alert a doctor on night shift, who might opt to call in a surgical specialist. The amount of monitoring ranges from intermittent checks by a technician who looks in and makes sure the animals are resting comfortably to 24-hour individualized care by a doctor.

Naturally, cats in the ICU are more closely watched than cats in C ward. Some of them are on ventilators; many more receive supplemental oxygen; others are on machines that register heart rates and rhythms and blood oxygen levels. Monitors are prominently displayed so that these cats can be easily observed by the veterinary staff on all shifts.

Cats placed in the C Ward are less sick. They may receive insulin or blood transfusions or be fitted with feeding tubes. Some are there to wait for diagnostic or surgical procedures scheduled for the next day.

Not all cats take being handled and prodded in stride, and owners sometimes worry about the impression their pets are making on the hospital staff. According to Dr. Rozanski, some people are very apologetic if the cat is mean to the specialists or technicians. She is quick to allay their concerns.

“The biggest thing for cat owners to recognize is that there are many cats that are great at home and horrible in the hospital,” she says. “They just don’t like having stuff done to them. We recognize that that is a trait in many cats.”

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