Friday, May 2, 2014

Phil's pills: how I stick to the prescription

Phil on his sick bed. (He also flakes out like this when he isn't sick, so it can be hard to tell).

This week poor Phil has suffered a flare up of his spectacular recurrent lymphocytic-plasmacytic rhinitis – a condition that causes him to sniffle, snort and produce monster boogers of dramatic proportions. It can obstruct his upper respiratory tract to such a degree that he can’t do much – eating, walking and even breathing become a challenge.

Example of a monster booger. Note it emerges from his right nostril, then silly-strings itself around his muzzle to form a complete circle. (There's not much this dog does that doesn't impress me).
He’s been examined multiple times and he’s back on pills - and much improved (thank goodness). But as someone who prescribes medication regularly I wanted to share my experience: I need a little bit of help to comply with the medication regime at home.

I want to discuss the word compliance firstly, as it is a word that people occasionally take offence to and it isn't meant in an offensive way. When we talk about compliance in a clinical setting, we talk about whether the patient or owner has been able to give the medication as directed – to follow the prescription. We don’t mean that compliance is good and non-compliance is evil. We aren’t power-hungry dictators forcing unruly pet owners to comply with our regime. We hope that pet owners and animal carers comply in the sense that medications are given according to the course, as they will be more effective and often this will reduce side effects.

There are plenty of reasons for poor compliance – yes, being slack is one, and yes, it does happen! - but quite commonly just struggling to administer medication is an issue (ever struggled to give an angry cat a capsule, only to have it spat out and rendered increasingly soggy, sticky and even more impossible to give?), so is poor communication (one member of the household thought the other one gave the dog his pill, and vice-versa), losing the medication (it happens), or simply forgetting a dose. [There are other types of “poor compliance” – such as administering via an inappropriate administration (sticking a tablet in a dog’s ear) – but they’re less common and I won’t discuss them here].

It happens, and vets are JUST as capable of forgetting as the next person. In hospitals it isn’t an issue because we have systems to remind us when meds are due, which kind and so forth. But at home we’re like every other pet owner – at the mercy of our own wits.

It can be even trickier when you need to give multiple medications, particularly when the dose rate of one or more of those meds changes through the course. The most common example is steroids. When we give steroids we aim to taper the dose to avoid side effects associated with sudden withdrawal – so early in the course you might be giving a full dose, which is then halved and later halved again.

This is the case with Sir Phil. When I prescribe meds to clients, especially steroids, I often say “it helps to write the doses on a calendar so you can check them off”. Not because I think my clients are silly. Far from it. It’s because I do it myself.

I don’t want to end up missing a dose, giving him an over-dose or an under-dose.

Here is my little chart for the current course of meds. I know there are uber-nerds out there using Excel, some might even use apps…this one works for us. (If you’re wondering why I’ve used the pink tablet/white tablet system, it’s for the benefit of Phil’s dog-sitter).

Phil's Pill chart. Note the pic. This is optional. (Its not like there's any danger of me giving the meds to the wrong dog, but in some households this could be an issue).
Easy as pie. And list-makers out there will appreciate the pure thrill of being able to tick these things off each time you give them. 

[And around that matter of compliance - if you don't think you can give a particular medication to your pet, let the vet know. We won't judge, promise. We've all met plenty of animals who evade our best clinical efforts, and treating them is easy once we work out the best formulation. Quite often an alternative to tablets is available, so don't be shy about asking].

So readers, how do you ensure that your pet receives all the required medication?