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August 2023
Cat Champions
Everyone from the client service representatives to the veterinary assistants and technicians can play a vital role in providing the best care to feline patients, especially in cases of dermatological problems.
How Each Team Member Can Advocate for Itchy Cats
Managing skin disease in cats is a challenging endeavor to say the least, and it oftentimes takes the help of a dedicated team to bring relief to our feline friends and peace of mind to their loving owners. Skin disease in cats can include allergies, bacterial skin infections, ringworm, parasites, and even immune-mediated causes. Although the general knowledge base along with the creation of an effective diagnostic and treatment plan fundamentally rest in the hands of the veterinarian, the team approach is essential in providing the highest quality of care. Everyone from the client service representatives to the veterinary assistants and technicians can play a vital role.
Client Service Representatives
No matter the presenting question or concern, the front desk staff—or client service representatives (CSRs)—serve as the frontline for the veterinary practice, whether in person or by phone. Many potential or even existing clients may call for a “phone fix” for their cat, looking for guidance on what to do for extreme itchiness or a smelly, dirty ear. It can be tempting to freely give out a Benadryl dose, guide them to a website to order an over-the-counter flea control product, or simply advise the owner to try putting a modified onesie on the cat to help stop self-trauma from creating a half-bald cat. But it is important to realize that this literal call for help serves as a first step on the road to providing a more definitive treatment plan for the patient.
No matter the presenting question or concern, the front desk staff—or CSRs—serve as the frontline for the veterinary practice, whether in person or by phone.
When scheduling an appointment, the miserably itchy cat should not be treated much differently than the vomiting or coughing cat in terms of urgency, as quality of life needs to be taken into consideration. The role of the CSR is to compassionately tell the client, “I’m sorry to hear that Binx is scratching so much, I’m sure he is so miserable. Let me try to find the soonest appointment with the doctor so that we can get him relief.” Moreover, enforcing confidence in the cat owner could include statements such as, “Our doctor will evaluate Binx, likely run some tests to rule out common causes of skin issues, and have a discussion about options to get him feeling better.” As with any dermatologic case, there may not be a quick and easy “fix,” which supports the need for an appointment with a veterinarian to discuss it in detail. Having clients first exhaust options on their own can undoubtedly lead to increased frustration and an emotional rollercoaster.
Once the patient has been seen at an initial appointment, most cases will need a follow-up appointment to ensure the therapies are working well, particularly during an allergy work-up. During the check-out process, especially if the veterinarian recommends a follow-up visit, the CSR should help guide the pet owner in making that appointment prior to leaving. Simply say: “I’m glad we were able to have Felix come in today to get him feeling better. We want to make sure that we’ve been able to keep him comfortable long-term by rechecking him in two to three weeks. Which day during the week of the 15th would work best for you?”
Finally, CSRs may oftentimes find themselves scheduling an annual check-up for a feline patient for general wellness and vaccinations; however, the owner may need to discuss other concerning issues going on with the pet during the veterinary visit. This can range anywhere from chronic diarrhea, inappropriate urination, and behavioral issues to hair loss, over-grooming, and other skin or ear issues. To help ensure that the scheduled appointment time allows for more discussion and work-up for a dermatologic case (rather than showing up as a “surprise” topic of discussion), it can be helpful to ask the client if there are any specific concerns that they would like to discuss with the doctor during the annual visit and adjust the allotted time accordingly. The amount of time scheduled for wellness visits versus visits requiring a diagnostic work-up varies between veterinary clinics, but having a longer appointment time scheduled can provide the necessary time needed for the entire veterinary staff.
Veterinary Technicians and Veterinary Assistants
In terms of maximizing the veterinary visit for the dermatologic patient, the veterinary technician plays the most important role. All too often, this part of the veterinary team is underutilized during the dermatologic work-up. The ability of the veterinary technician or assistant to perform certain tasks may vary depending on local and state regulations.
In terms of maximizing the veterinary visit for the dermatologic patient, the veterinary technician plays the most important role.
The following roles should be considered during the appointment:
- Initial intake questions: A template or typed dermatology-centered questionnaire can either be provided to the owner to fill out in the waiting area or serve as a standardized “script” when interviewing the owner at initial intake. Sample questions include: “When did the itchiness start?” “Does the itchiness occur seasonally or nonseasonally?” “Are other cats or dogs in the house affected?” “Where does your cat seem to focus most in terms of scratching, biting/chewing, licking?” and “When is the last time any flea prevention was applied to your cat?” In most areas of the United States, a brief but informative discussion on the importance of parasite control in cats, particularly fleas and their life cycle, can reinforce this recommendation during the appointment.
- Recheck questions: The follow-up visit should involve confirming what medications have been given, how effective the owner feels they are working, and also complimenting the owner not only with following up as directed, but also taking on the challenging task of at-home treatments in a cat.
- Taking ear and skin cytology: The act of sampling an ear or affected area of skin for cytology does not require a veterinary degree, although it does involve time and effort on the veterinarian’s behalf to train technicians and assistants on how to perform this skill. Not only does this allow for a more time-efficient appointment, it strengthens the technician’s or assistant’s confidence in explaining the importance of performing ear and skin cytologies to the owner. Having the results of these cytologies even before walking into the exam room can immensely expedite the veterinarian’s conversation with the owner about recommendations for treatment or further testing.
- Interpreting ear and skin cytology: As with the act of sampling, the process of interpreting ear and skin cytology slides is another skill that can be taught to veterinary technicians and assistants. Ear cytology tends to be subjectively easier to interpret compared to skin cytology, although with proper time and training, many technicians and assistants can become confident with interpreting skin cytology slides as well. In either case, having a veterinary team member sample for cytology and possibly interpret the slides will allow the attending veterinarian to have more time to discuss expectations and options with the owner during the appointment.
- Reviewing medications and offering tricks on how to administer them: Oftentimes, owners may be overwhelmed with the overload of information at a veterinary visit, especially if skin issues are not the only point of discussion during the appointment. Having technicians or assistants review the labeled medication instructions as well as tricks to giving medications to a cat prior to check-out is an effective way to reinforce the recommendations from the visit and ensure that the owner feels comfortable with at-home care. In many cases (unless treatments are administered in-clinic), the owner is given the major responsibility of carrying out treatment recommendations, but if they cannot follow through, then improving the cat’s quality of life will not be achieved.
Nothing can be more frustrating than rechecking a cat with skin issues and finding it has not improved since the initial visit, especially if this is due to lack of compliance on the owner’s part. Bringing relief of itchiness and improving the overall quality of life of the cat can be better accomplished if a veterinary technician or assistant can follow-up with the owner after the initial examination, typically within a week of the appointment. Depending on the owner’s comfort level and preference, or the practice’s capabilities, this can be achieved through a phone call, an email, or possibly even text messaging with proper documentation of the conversation in the patient’s medical record. The modified treatment plan can be communicated through the veterinary technician or assistant based on the veterinarian’s recommendations if the cat, for example, is not cooperative with receiving medications, is experiencing side effects from medications, or is not accepting of a diet trial food. The follow-up appointment can be more productive if these problem areas have been addressed beforehand.
Veterinarians
Formulating and guiding the diagnostic work-up in addition to creating treatment recommendations ultimately depends on the veterinarian, aided by the support staff. There is no doubt that the dermatologic feline patient can be more of a challenge compared to their canine counterparts. For example, the overall clinical presentation of the allergic cat can look very different from the dog, specifically with miliary dermatitis, overgrooming, and the eosinophilic granuloma complex (indolent ulcers, oral granulomas, eosinophilic plaques). All of these clinical presentations should be evaluated for external parasites with flea combing, skin scrapings, and oftentimes trial treatment with broad-spectrum treatment for external parasites (e.g., isoxazolines). For the nonseasonal presentation, a restrictive diet trial with a veterinary prescription diet (hydrolyzed or novel protein/novel carbohydrate) should be fed for eight weeks. Other diagnostics, such as a fungal culture and dermatophyte polymerase chain reaction test, may be needed in cases of alopecia or miliary dermatitis in order to rule out ringworm. For atypical presentations (e.g., nodules, plaques, severe crusting), a skin biopsy may be warranted in order to diagnose the disease more definitively, which then provides a better approach to discussing treatment options and prognosis.
There is no doubt that the dermatologic feline patient can be more of a challenge compared to their canine counterparts.
The most important part of the veterinary visit is having the discussion of expectations with skin disease in general. Clients should be made aware that the road to discovering a definitive diagnosis (food allergy, environmental allergy, pemphigus foliaceus, or other) may involve multiple visits and various diagnostic tests or trials, as not every type of skin disease has a “quick and easy” diagnostic that can offer answers by the next day. Furthermore, even in well-managed skin disease such as environmental allergies, flare-ups can occur from time to time, and clients should be made aware ahead of time that adjustments might need to be made. Having these discussions with cat owners at the beginning does not necessarily make the diagnostic road shorter; however, understanding how the process works and what to expect from it can certainly provide a better peace of mind for the owner.
Unless there are other medical concerns going on (e.g., diabetes, heart disease), a tapering course of oral steroids should be considered in many cases of itchiness during the work-up period to provide faster relief from itchiness in addition to instilling trust in the pet owner that the veterinarian is working to find a solution. Longer-acting steroid injections should be avoided if possible due to safety concerns with congestive heart failure, diabetes, and fragile skin syndrome.
If the initial veterinary visits are not providing enough resolution for the patient or the clinical presentation is beyond the comfort level of the veterinarian, then referral to a veterinary dermatologist should be discussed as an option with the owner. This should be viewed as a partnership, or even a collaborative effort, rather than making it seem to the owner that the veterinarian has “given up” on the case. Open communication with a veterinary dermatologist through email or fax by providing a patient history, pertinent bloodwork, cytology findings, skin culture results, biopsy findings, and treatment results can immensely help streamline the referral process and help the team expedite treatment success.
Andrew Simpson, DVM, MS, DACVD, is a 2009 graduate of the University of Florida College of Veterinary Medicine. He spent four years working as a general practitioner at various VCA animal hospitals in the greater Chicagoland area, then finished his residency in veterinary dermatology along with a master’s degree at the Colorado State University College of Veterinary Medicine and Biomedical Sciences in June of 2017. His interests include allergic skin disease, otology (ear disease), immune-mediated skin disease, and cutaneous manifestations of systemic disease. |
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