If Your Veterinarian Can't Help

Unwilling To Treat Cats

I received a heart-rending e-mail from a woman in India, who had three cats dying of mange. In that particular area, vets were not particularly interested in treating cats.

Apparantly, there were at least two reasons:

Cats weren't really considered pets. If you want a real pet, get a dog!
Cats were considered disposable. If you insist on having a cat, and it gets sick, just get another.

In this case, the woman kept trying, and the fifth vet was willing to treat her ailing cats. But this vet didn't know what to do.

So, lesson #1 is "keep looking." To save stress on both you and your pet, use the telephone to call local vets until you find one willing to work on a mangy cat.

If you are completely unable to find a veterinarian willing to help, it is time for desperate measures. Please see our page on Home Mange Treatment.

Unwilling To Treat Cat Mange

Lesson #1 is "keep looking." To save stress on both you and your pet, use the telephone to call local vets until you find one willing to work on a mangy cat.

If you are completely unable to find a veterinarian willing to help, it is time for desperate measures. Please see our page on Home Mange Treatment.

Vet Wants To Help, But Uncertain What To Do

Veterinarian spend years learning how to diagnose and treat animals. Their education is actually more complex than that of physicians tending to human patients, because they have to learn about not only a spectrum of disorders, but also of numerous patient species.

It is not surprising if some very knowledgeable veterinarians know little about mange.

vet school may speed through this topic
in some regions, mange is rare - so the vet gets little practice with it

I am not formally educated in this field, but I want to do as much as I can to assist veterinary professionals in dealing with this scourge.

Please direct your veterinarian to the following pages, or print them out and take them in when you visit:

Treatment Attempted, But No Significant Improvement

This section is intended for those who have obtained professional veterinary care, but their pet has made little or no progress.

Possible Reasons

In cases like this, there are several possible explainations for what is going on:

The diagnosis is incorrect - it is mange, but was treated as if it were something else
This may be fairly common, because to really confirm a dignosis of mange, the vet has to take skin scrapings and examine them under a microscope. If he finds the mites, the diagnosis is confirmed. But if he doesn't see the mites, it could just be because the particular area that was scraped didn't happen to have any mites. Move an inch to the left and try again! This can be a time-consuming and expensive process.
The diagnosis is incorrect - it is not mange, but was treated as if were mange
The diagnosis is correct - but the selected treatment is not appropriate
The diagnosis is correct - but the selected treatment is not effective
The diagnosis is correct - but the selected treatment is not effective enough
Some forms of mange are much harder to cure than others. For example, if you have a really tough case of Demodectic Mange and treat it with relatively gentle lime sulfur dips. The dips will probably eradicate the mange, but it will take several months - the cat might not survive long enough to be cured!

Presumptive Diagnosis and the Zebra Effect

Because of the difficulty of confirming certain diagnoses, veterinarians often make a "presumptive diagnosis". This is a form of educated guess, and is a completely valid technique. The disorder looks like it might be A, B, or C. So they treat for A, if that doesn't help, they treat for B, then C.

This is not just the case for veterinarians. Even when a human is the patient, some symptoms are not terribly specific. Consider the case of body temperature elevated above the normal level (i.e. a "fever"). This symptom can arise from numerous causes: infectious diseases (such as pneumonia and tonsillitis), disorders of the brain, certain types of cancer, and severe heatstroke. Which possible cause is responsible for the symptom ... this time? Some causes may be rejected out of hand. The physician may run tests to rule out other possibilities. He may buy some time with symptomatic relief (e.g. a cool bath), so the fever doesn't kill you. Whatever is left becomes the presumptive diagnosis.

How does a doctor or vet choose which possibility to investigate first? They gamble that the most common cause is the most likely for this case. In medical school, they teach "When you hear the sound of approaching hoofbeats, think horses, not zebras." Because, in most places, horses are more common than zebras.

There are problems with that approach:

If mange is C in the list of possibilities, significant time may elapse (treating A and B) before mange treatment begins. The cat may not survive long enough to start mange treatment. It's tough being a zebra in a world of horses.
If the mange treatment is time consuming (e.g. numerous dip treatments), the cat may not survive long enough to be cured.
Some pet owners can not afford extended treatment, or a series of speculative treatments.

Why am I droning on about presumptive diagnoses, zebras, and speculative treatment? I want to make this point: just because your vet has not produced immediate results does not mean that he is not competent. It just means that the job is difficult.

So, what to do?

Suggestion

At this point, I would like to make a suggestion...

Treating mange with Ivermectin is simple and inexpensive (.20 mg/kg, SC, two treatments 2 weeks apart).
It is low stress for the animal - most cats dislike baths and dips, but an injection is quickly over.
It is easy for the owner (two office visits), and reasonably inexpensive.
If Ivermectin is the right treatment, results are rapid (see: recovery sequence).
Ivermectin is off-label for mange in cats, but appears to be safe for adult cats.

If there are no contraindications, why not give it a try right now?