If you can't get the pill into the patient...
I have a secret fear that most of what I do is futile.
I don’t mean that in an existential way, as in the sun will explode in 6 billion years, so why bother? I mean it in a very real-world way: most of the time spent doing what I do professionally (when it comes to treating ill patients) might as well be spent picking daisies or writing haiku about shrimp.
And exactly why am I getting this sinking feeling? In a word – compliance.
Compliance refers, in part, to owners filling a prescription and successfully getting the medication into the patient. Some estimates of veterinary compliance are as low as 20% to 30%. That seems pretty futile to me.
Writing a prescription is the easiest thing in the world to do – jot-jot, scribble-scribble, illegible signature and *BAM* instant wellness! A trip to the pharmacist and Bob’s your uncle, you’re healed. Except it isn’t that easy.
Somewhere in between the jot-jot scribble-scribble and the Bob’s your uncle bit, things fall apart. The center does not hold.
Have you ever tried to pill a cat? I think, for certain felines, counting the blades of grass in Central Park or the grains of sand on Oahu might be easier, and certainly more fun. Those sharp feline teeth are clamped shut tighter than a schoolmarm’s bun (BUN – I said BUN, as in hair) and many pet owners don’t have the intestinal fortitude needed to deliver the pill and start the healing.
So – as I said, futile. I can write prescriptions all day long until the cows come home (which I assume is at the end of the day, or somewhere near it) but if you can’t get the pill into the patient, well...
Shrimp, swimming like cats
Glabrous, like wee newts
Hovercraft in flames.
I know – amazing.
Dogs are only slightly easier to medicate; we have an edge in that dogs consider the world largely edible with very few exceptions, and can be tricked into swallowing pills wrapped in cheese, ham, butter or (for all I know) shrimp or wee newts. But many dogs fall into the same resistant category as cats, and if the pills don’t go in, the healing can’t begin. (Apparently, I am on a bit of a poetry bender.)
Dogs and cats have amazing healing abilities, so I am not implying that modern medicine is the only way that a pet can get better. We have an old saying regarding cats that if you get all the parts together in the same room and close the door, they’ll heal. They are that good at it. But in many cases, the medicine really, really, really needs to get in or the pet just won’t get better. As an example, we commonly use a diuretic called furosemide (or Lasix) to help pets in congestive heart failure. Lasix is a bitter little pill that tastes like Satan’s ashtray. If the dog or cat doesn’t get its pill, fluid builds up in the lungs, they have trouble breathing and it all comes apart. If the pill goes in, they merely pee out the extra fluid and, Bob’s your uncle, everybody’s happy.
Similarly, we’ve all heard the old saw about finishing your course of antibiotics. Here’s why it’s important: If you only finish half of the prescription, you have merely succeeded in killing off the wimpiest of the bacteria, leaving the robust and hearty, stronger bugs around to create infectious mayhem. So what to do if your cat decides that he no longer would like to take those icky bitter pills, thank you very much, after you have started the prescription?
Well, you don’t have to resort to bad poetry. All is not lost. There are some things you can do to help the meds get where they need to be. Here are some tried-and-true methods to help deliver wellness when your pet decides your energies would be better used counting blades of grass:
- Lunchmeat is the classic. Wrap the jagged little pill in low-fat deli meat such as turkey or chicken, and many an unsuspecting dog will wolf if down (and, who knows, a wolf may dog it down if you ever need to treat a wolf). Also acceptable: American cheese. ProTip! Try liver sausage (aka liverwurst or Braunschweiger) for an inappetant dog! 100% success in my hands.
- Use things you yourself would never eat! Along with liver sausage (bleccccccch), cheese in a can will work wonders. It is often the secret to getting a dog to take his meds. Cats, not so much. For dogs, the grosser and stinkier the better; dogs are like third grade boys. Keep that in mind and you can’t go wrong.
- Butter them up: Peanut butter and good old-fashioned butter are tasty and have the advantage of lubricating the pill’s descent into the gullet. (You’ll need divine help if the dog spits it out and you need to give it again, though – that’s one slippery little sucker, to paraphrase Julia Roberts in Pretty Woman.)
- Use a gun: No, not that kind of gun! A ‘pilling gun’ has a little rubbery bit on the end that holds the pill and a plunger to deliver the goods to the back of the throat. This way, your hands stay clear of those sharp teeth and you have a better chance of getting the pill in the sweet spot where swallowing is easier than spitting it out. All vets carry them and so do pet supply retailers. Great for cats, who may not be fooled by your pathetic attempts at bribery with (*shudder*) liverwurst. As if.
- Get creative: One of your best friends in the battle against poor compliance is your veterinarian. And they have a secret weapon, too: compounding pharmacies. A compounding pharmacy is to a regular pharmacy what a unicorn is to a horse; similar, only better. Compounders can take that horrid-tasting icky pill and, as if by magic or alchemy, transform it into a delicious meaty treat or liquid. Compounders are perfect for cats, and even perfect-er for cats that need to be on chronic medications. They can flavor it with tuna, chicken, beef and possibly even mouse or unicorn flavor. (I have it on good authority that unicorns taste like a mixture of marshmallow fluff, Cap’n Crunch and crystal meth.)
- Set phasers to ‘liquefy:’ Some veterinarians carry liquid forms of many medications, but many of these are just repackaged human pediatric suspensions, and many come in none-too-appealing flavors like bubble gum. I have yet to meet a cat who chews bubble gum. Still, many folks consider a liquid form easier to administer than a pill.
- Wrap that rascal: Pill Pockets and similar products are soft little edible pouches intended to be wrapped around a pill to hide the smell and taste and encourage pets to take their medicine. Most dogs will not think twice about snarfing them down and even some cats will fall for this tactic. Many vets carry them, and pet retailers have them as well. Several brands exist, and they come in several flavors to match your pet’s preferences. (No unicorn flavor.)
And, if all else fails, there’s YouTube. There are many good videos on how to pill a dog or cat, and seeing it done may give you the confidence to go out and do it yourself. And don’t forget to ask your veterinarian to have them or a technician show you how do it while you’re there. When you get home is no time to realize that you have to push that bitter little pill past those gleaming chompers.
If you are going to pill the pet yourself and avoid making them think the pill is actually a piece of yumminess, there are a few tips, too. For cats, gently push the cheeks against the molars as this will encourage them to keep their mouth open in order to not bite themselves (sneaky, but effective). Drop or place the pill as far back on their tongue as you can get it. As mentioned above, there is a balance spot on the back of the tongue where swallowing becomes almost a reflex and spitting the pill out is less likely to happen.
Next, gently hold the mouth closed and give a puff of air into the nose. I know – this sounds nuts, but it works! (Caveat: some pets won't like this and may bite your face. Some animals really, really do not like it.) When they lick their nose, the pill has gone down. (The poet in me wanted to write when they licks their nose, the pill has goes, but it just didn’t work out. Sometime the muse abandons you.) I have no idea how this came about evolutionarily, but when a cat licks its nose after you have pilled it, it means the pill has successfully gone down the chute. Perhaps ancestral cats had some sort of survival advantage doing this when they lived in Gondwanaland, I don’t know.
And that’s it! Pills on board, disease conquered, healing started. You can do it. You might need a little help in the form of liver sausage or a unicorn, but it can be done. Thank you for making me feel a little less futile today.
Now, on to my important work into preventing the sun from exploding. I have a little time to work on this one.
April 3, 2021
Wendy Smith Wilson, DVM
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Dr. Nathan Mueller
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VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.