Here are some of the simpler medical treatment options which don’t require stressful or traumatic handling:
 
FLEAS:

When safe-handling is impossible, CAPSTAR pills crushed in food are a safe and effective flea treatment for cats and kittens 4 weeks and older. Capstar does not require a prescription and can be purchased online at any of the PetMeds-type websites. Capstar works in 3-6 hours at which time the cat/kitten may be brought anywhere without fear of risking flea infestation if you dispose of the infested bedding. The pills can be crushed and sprinkled onto a small amount of a tasty food. They have no unpleasant taste. Capstar has no residual effect so the cat/kitten must not be re-exposed to fleas. (Advantage, Revolution, etc. continue working for one month). Half of the cat pill is a safe dose for 4 week olds.

EAR MITES:

REVOLUTION requires a prescription but will effectively treat Ear-Mites in one treatment; (it also treats fleas and roundworms effectively at the same time). Briefly handling of the cat/kitten is necessary to squeeze a small amount of the Revolution liquid onto the cat’s skin between the shoulder blades. This can be done at the time of a vet exam or after the Spay/Neuter surgery. Other EAR MITE treatments require fourteen days of twice daily ear drops with a refrigerated product like TRESADERM. This is stressful and traumatic for fearful kittens. Cold ear drops twice a day for two weeks is not a good recipe for socialization. Some say Revolution doesn’t work,  but in the right dose, it has worked well for us every time.

VIRAL INFECTIONS:

Treating eye infections can be very difficult but must not be neglected. Scarring and loss of vision is common with untreated Herpes virus eye infections (Herpes is the R in the FVRCP vaccination). If you are required to use the standard tubes of eye ointment (Terramycin, etc.) or drops, be sure to undo the bad experience of being restrained and treated for the eye problem, by spending extra nurturing time with the kittens before and after treating the eyes with the proper eye ointment or drops. Make sure you have the correct diagnosis since treating with the wrong eye medication can be useless or even harmful. Antibiotics have no direct effect (read about Zithromax below) on viral infections like URI (Upper Respiratory Infection) but often vets will prescribe one to treat or prevent a secondary bacterial infection. This is usually easily mixed into food without handling the cat. Make sure you can follow the directions precisely or don’t treat the cat at all. Antibiotics are not a “hit or miss” medication to be played around with. Ask the vet if you’re not sure!  Zithromax (Azithromycin), has been found to be nearly 100% effective for resolving kitten and adult Herpes eye infections. Although it is an antibiotic and we all know they can't cure viral infections, vets are documenting that an Azithromycin course of treatment resolve Herpes eye infections. It can be compounded with flavors and stirred into food, avoiding the need to restrain the animal to treat it. It can be ordered with a prescription from Vet-Centric and mailed to you.  The medicine itself is not perishable but some of the flavor compounds are and need to be refrigerated, so try to stick with the non-perishable flavorings. We use the "Roasted Chicken and not the "Tuna" for example.  The success of this treatment for herpes is unexplained and "off-label" so your vet may not be aware of this seemingly miraculous if counter-intuitive treatment.  The eye ointment treatments are usually unnecessary if the Azithromycin is used.

PARASITES:

Most vets give STRONGID for ROUNDWORMS as a matter of course (must be repeated once 14-21 days after first treatment). This can often be put in food and gobbled up without detection. Strongid is a very effective and safe medicine but will not resolve other parasites such as COCCIDIA or GIARDIA. These others are less frequently seen, but very common. Diarrhea can be very serious to kitten health and should not be neglected. An exact diagnosis can be difficult to get but if diarrhea persists, take a stool sample to your vet for testing. The test for Giardia is more expensive and not normally run as a matter of routine. Be sure to ask the vet if he thinks it is necessary and offer to pay the extra to have it done.  The routine treatment for Giardia is 10-14 days, twice per day of a very bitter drug called Metronidazol or Flagyl.  It is impossible to disguise this drug in food and usually makes the most tame housecat impossible to pill after one taste.  One company has started making the drug in coated pill form but most Vets only stock the large dog size pill that breaks into powder when you dose it for cats. A better alternative for treating Giardia in the feral cat or kitten is Panacur liquid suspension.  It comes in powder but the liquid is easier to mix in with food.  It has a chalky taste which gives you a much better chance of sneaking it into food.  It’s a once per day treatment for only 5 days which is much less than the bitter pill regimen.   

RINGWORM:

One of my professors told me, “It takes 21 days for Ringworm to heal if you treat it and 3 weeks if you don’t treat it.”  I once treated a young feral kitten for ringworm and she never was comfortable being handled as a result of the treatments.  Her sister was too feral to be treated at all and she healed on her own with good nutrition. 

Oral medications for Ringworm were often avoided by vets because of the damage they can do to liver and/or kidneys.  The only treatment our vet approves has given us very good results without the dangerous side effects, ITRACONAZOLE.  It is given easily in food once per day for two weeks and then once every two weeks after that until it is resolved. The medicine fuses to the hair follicle and we've seen great results with this in short order.   It is a liquid which doesn't have a bad taste and is easily disguised in food.  You can get it compounded with flavorings but may then need to be refrigerated.  

SPORONEX, another liquid medication often used for human children, works well too but is much, much more expensive.

In the past, we had noticed that some strains of Ringworm appeared to respond very well to a double dose of the flea treatment PROGRAM. Some rescuers still swear by this treatment, although a recent Veterinary study claims to have proven that PROGRAM does not work for Ringworm at all.  It comes in a chewable tablet form that is very palatable and can be crushed into food and cats gobble it up.  This “off-label” use of PROGRAM to treat Ringworm was used by many vets.  They were safely using DOUBLE the dose on the package recommended for flea treatment.  When it appeared to work,  we saw dramatic results right away. However, kittens often recover very quickly from ringworm with good nutrition and no treatment at all, which may explain why we thought it was the PROGRAM treatment that was curing them.  

Spend money on some high-end nutrition (Natural Balance, PetGuard, Wellness, Eukaneuba for example) no matter what course of treatment you take.  A healthy immune system can cure Ringworm all by itself, if you help it out.

Our vet no longer does any of the sulphur dips, baths, topical creams on any cats, especially not on a feral cat or kitten.  She's found that they don't speed up the healing, and definitely slow down the socialization process for a feral.  To continue socializing sessions with cats/kittens with ringworm, just take precautions for yourself. Use washable cloth or latex gloves and using a "dedicated" set of clothing that you wash with bleach between sessions (including shoes, or just wear socks you can wash).  With a minimum of common sense (long sleeves, etc), you can continue socializing the kittens and by the time they are tame, the ringworm will be gone too and they will be ready for adoption.  If you catch some spots of ringworm yourself, any over the counter athlete's foot spray will control it for humans, or the creams like Miconozole, or any one ending in "-zole." These are all anti-fungal medications (Ringworm is a fungus after all).  These creams aren't good for cats because they will just lick it off which is unhealthy and therefore also useless.  There are some special topical veterinary preparations for ringworm, but our vet has stopped using them for all of the above reasons.  Your vet may have his/her own specific methods which you should always follow, or discuss the options along with his or her logic for their method.  Do what your vet says, or change vets!  Don't mix and match treatments, which can have dangerous consequences.  WE DON'T KNOW BETTER THAN THE VET!

Hang in there. With cleaning, vacuuming, bleach laundry and high heat drying, THIS TOO SHALL PASS! 

ANTIBIOTICS:

Ever try to give antibiotics twice a day to a feral cat? If you have, you'll be jumping for joy as you read this news.   There is an "off label" use for cefovecin (Convenia™) which allows a one-time injection that provides 7-14 days of antibiotic treatment for cats.  This means that a feral cat which is discovered to have an infected wound or need teeth pulled at the time of TNR could get this one shot while still knocked-out for the neutering, and not need the twice daily regimen of antibiotics we've all faced in the past. Remember praying that s/he eats it in the food? Trying to pill them once of twice and then giving up, or risk a course of antibiotics yourself?  Needing to hold the cat for treatment when you have nowhere to hold them!?!  All of that is over!

It's termed "Off-label use" because Cefovecin (Convenia™), is only been tested and approved for treating dermatological problems but doctor's have found that it works for many other things and has the aforementioned 7-14 days of residual effect.  This is similar to using Program™ to treat ringwomr which is actual a product for fleas.  Studies have shown that the only side effects (rarely seen) may be some nausea for a couple days but don't last for the entire 7-14 days.

This is already in use in NYC at West Chelsea Veterinary on 26th street for one but hopefully your vet will be open to learning about using it too.

If your vet doesn’t understand the challenges of socialization and building trust, there are many vets who do and will work with you to get the kittens to optimal health without using treatment methods that undo your hard work toward socialization.  Ask around for a recommendation from one of the many groups working with feral cats.   

The kittens AND YOU, deserve all the help and understanding you can get!!        

Written by Mike Phillips, Licensed Veterinary Technician,
President, URBAN CAT LEAGUE