Have you ever been presented with a cat you are certain has hyperthyroidism, but you can’t prove it?
It is losing weight, but is eating ravenously, has a rapid pulse and, on occasions, has a palpable goitre – but can you detect an elevated total T4? No way!
Despite sometimes testing two or three times, its total T4 sits firmly within normal range.
The answer to this is to get a free T4 done – and lo-and-behold, this often confirms hyperthyroidism.
I’ve come across a couple of cases of Sarcoptes this winter. Both cases were young dogs with intense pruritus – one on his face and the other around the triceps region.
Although both owners were rather sceptical, both dogs responded very rapidly to therapy with imidacloprid/moxidectin (Advocate, Bayer).
In our neck of the woods, I tend to try trial therapies first as we have a high urban fox population, but perform ELISA blood tests for Sarcoptes in dog cases with persistent signs.
I occasionally do skin scrapes but rarely, if ever, find mites!
Video of the S. scabiei mite. Author: My Core Competency is Competency at en.wikipedia
We had a very sad case lately of a little kitten that developed the classic signs of wet feline infectious peritonitis (FIP), had a very high titre to feline enteric coronavirus (FeCoV), responded poorly to treatment and went on to develop neurological signs with the inevitable outcome.
This horrible result was made all the worse as he had a little brother…
As his new owners were thinking about getting another kitten, we thought it worth checking titres on our apparently healthy brother. The first titre was low and indicated exposure, but a second was sky high – so we’re really hoping he is one of the 90% that bats this off without developing the mutated form of the virus.
As a result we have suggested his owners delay introducing a new cat for the time being.
We do a lot of work for the local branch of the RSPCA and come across all kinds of squitty kittens with varying degrees of diarrhoea, which (on occasion) respond poorly to symptomatic therapy.
We have found it worthwhile to do the full faecal screen, which includes a whole range of PCR diagnostic tests.
This enables us to diagnose a range of infectious agents – feline parvovirus, Tritrichomonas foetus and feline coronavirus to name just three.
At least then we can explain why our kitty is not responding to treatment!
Quiet, lethargic, not eating very much and just generally a bit slow? It’s worthwhile tapping the abdomen.
I saw a golden retriever presenting in just this way, just as surgery was about to close on Christmas Eve. On examination she was a bit pale but not particularly tachycardic, although her abdomen felt distended.
A quick needle tap sadly revealed the presence of free blood. However haematology showed a significant reticulocytosis consistent with the bleed occurring 2-3 days previously (the owner did point out that, in fact, she had started to perk up that morning).
Our next step will be some imaging to see what the spleen looks like and whether we can consider surgery – hopefully with a favourable outcome. Fingers crossed.
Dr Lisa Powell from the University of Minnesota’s College of Veterinary Medicine describes how to perform an abdominocentesis (peritoneal tap) – the procedure used to obtain free abdominal fluid.
I recently saw a very large, and very friendly bull mastiff that presented with what appeared to be typical interdigital cysts. These had been chronically recurrent and previous histopathology indicated a pyogranulomatous reaction.
However his lesions responded poorly to three weeks’ of cephalexin antibiotic therapy and, in fact, he developed several lesions on his other feet.
Cytology revealed mild bacterial colonisation, and it occurred to me this might be an immune-mediated reaction (his blood work and TSH/T4 were all within normal limits) – and, hey presto, we got a rapid clinical response to steroids.
In spite of being under control he has also developed an acute erythematous otitis externa, so I think a food trial is my next line. Watch this space…
I suspect we have all come across that tricky Pseudomonas otitis case that just seem to refuse to completely respond to antibiotic therapy in spite of extensive investigation for underlying causes.
I had just one such case recently that, in spite of culture and sensitivity, blood work, skin biopsy, extensive flushing, lack of response to licensed products (and so on), just refused to respond.
A quick look through one of my trusty text books* suggested Ticarcillin.
Ticarcillin potentiated with calvulanic acid (Timentin) is an extended spectrum penicillin that often has good activity against Pseudomonas. The 100mg/ml antibiotic solution can be applied directly to the ear canal as a drop.
The case I’m treating has responded really well.
* Reference: Hill, P.B. (2002) Small Animal Dermatology: a practical guide to the diagnosis and management of skin diseases in dogs and cats. Butterworth-Heinemann. London.
Last Saturday I had a “walk in” – a very cute spaniel that was limping slightly and had a cut pad. The owner thought she might have trodden on something.
A good palpation didn’t seem to suggest the presence of any foreign body and the dog was very stoical. My previous experiences suggest any foreign material produces a lot of pain that is exacerbated by palpation – sometimes with dramatic effect!
However, the insistence of the owner made me look closer and I could just see a glint of a firm object deeply embedded in the pad. A pair of rat toothed forceps later and I extracted a 5mm slither of glass from the pad.
The result was a happy dog and owner, but oh – I could so easily have sent that poor dog away!
Vets are always taught, quite rightly, the power of effective history taking. The value of it is undeniable, particularly in certain disciplines, such as dermatology.
However, over the years I’ve learned to clarify with owners exactly what they are saying. For example, I’ve found “he’s not eating” means quite different things to different people.
The “so what I understand from what you are saying is that he hasn’t touched his food for a week?” question can sometimes produce an “oh no, it’s just he hasn’t eaten his Boneo/prawns/mixer (delete as appropriate) for the past few days”, or “she’s eating human food, but not her own food” is another common reply. So it’s always worthwhile just clarifying with owners what they mean – you might be surprised by the reply.
I’m a bit long in the tooth now, but I still found the whole procedure a bit scary given the size and vascularity of the uterus – and this made me reflect on the benefits of early neutering.
We routinely spay bitches in our practice from five months of age with minimal long-term complications, and it’s so much easier.
I am aware that recent research indicates early neutering may have some long-term implications in certain breeds, but the procedure is so much safer in young dogs, and anything that prevents them developing pyometra in later life has got to be an advantage.