Demodex gatoi is an unusual cause of pruritus in cats, but given the challenging nature of establishing a diagnosis in cats (Hobi et al, 2011) it is well worth ruling out this parasite as a possible cause (Moriello, 2015).
Karen Moriello reports finding this more oval, rather than cigar-shaped, form of Demodex more frequently in faeces (by faecal flotation) than on skin scrapes due to the cat grooming and ingesting the mite.
The good news is that, if we do find the mite, it is possible to treat (off licence) with Advocate Cat once weekly for six weeks.
References
Hobi S, Linek M, Marignac G et al (2011). Clinical characteristics and causes of pruritus in cats: a multicenter study on feline hypersensitivity associated dermatoses,Vet Dermatol, 2011.
Moriello, K.A. (2015). Itchy Cats: Evidence Based Diagnosis and Treatment, North American Veterinary Conference, Orlando 2015.
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.
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!
Many clients have difficulty persuading their cat to take tablets. Image source unknown.
OK, a potentially controversial one this…
There is a lot of evidence highlighting resistance to antibiotic therapy both in the human and veterinary fields. My understanding is that this is, in part, due to poor compliance.
I’ve certainly come across clients who have difficulty giving tablets to their cat, and have also seen cases that “appear” to respond poorly to amoxicillin/calvulanic acid but then respond rapidly to Convenia.
So, my argument is that injecting a long-acting preparation licensed for the treatment of soft tissue infections in cats (having bactericidal activity to the “usual suspect” oral bacterial flora of the cat) is preferable to giving oral meds that owners find difficult, and in some cases impossible, to administer.
I might even suggest this may result in less resistance.
Image by Nancy Wong (Own work) [CC-BY-SA-3.0], via Wikimedia Commons.I find retching cats usually present last thing in an evening surgery, leaving you with that tricky choice of whether to anaesthetise and investigate immediately, or delay until the next morning.
It also seems to be the ones you delay (because they’ve eaten, of course) that do have a grass blade while, more often than not, the ones you investigate there and then don’t.
Anything there?
A young colleague showed me a nifty way of elevating the soft palate with a spay hook, which neatly reveals the presence of grass (or not, as the case may be).
Some careful work with the crocodile forceps and you can usually whip out the offending blade of grass very easily.
I had a poor feline with a very blocked proximal urethra, and numerous attempts to pass various kinds of [feline] urinary catheter proved unfruitful.
I’m indebted to a young colleague who helped by using two stay sutures through the prepuce to hold the penis in position – this puss was in good body condition, and this really helped expose and stabilise the penis.
My colleague then used a 22G venous catheter inserted to the level of urolith, and a bit of hydro-propulsion, and we had easily passed a catheter.
Catheter options: The standard (Jackson-type) tomcat catheter (A) is stiff with a metal stylet and has rough side holes, so is traumatic.
The Slippery Sam (B) has end hole or side holes, is atraumatic and stiff, so good for initial unblocking. The Little Herbert adapter (C) is also shown as it makes it easier when attaching the catheter (B) to a closed collection system.
The hub of the Slippery Sam catheter is not firmly attached to the insertion tube, so it is recommended not to be left in situ more than six hours. The Fioniavet tomcat catheter (D) has an end hole, is atraumatic and stiff, so good for initial unblocking.
Noel Fitzpatrick runs one of the most advanced veterinary practices in the UK.
In my interview for Glasgow vet school, I was asked the question “how far is too far?”, and recent episodes of The Supervet on TV had me musing on the topic again, particularly as I had used The Bionic Vet as an example in my answer.
At the time I discussed kidney transplants in cats in the US and, in the UK, the inspiring work and pioneering techniques being carried out at Fitzpatrick Referrals.
Arguably the most famous patient of Noel Fitzpatrick’s is Oscar the cat who, after having both back paws cut off by a combine harvester, had prosthetic legs specially engineered and fitted (see video below). Oscar’s surgery was the first of its kind, and a huge step for orthopaedic veterinary medicine worldwide.
While this type of surgery was a world first in cats, prosthetic limbs are not an alien concept in human medicine – and, at a time when the emphasis on “One Health” becomes stronger every day, why shouldn’t routine or even rare human procedures extend their applications to our domestic species too?
But at what point do we say that medical advances are not ethically suitable for animals? A person may have a reasonable quality of life in a wheelchair, but that doesn’t mean a dog with wheels for back legs would. Such a “cart” would dramatically effect the quality of life of cats like Oscar, but his new legs have given him the freedom to continue to “be a cat”.
Each individual case is different, and the benefits and risks of undertaking a new, advanced technique would have to be weighed up accordingly. I don’t believe the point at which we draw the line on “going too far” is set in stone – every case is unique.
Kidney transplants in humans are life saving, and yet not seen in the UK in cats. A cat with kidney failure would gain a lot from a transplant, providing the risk of rejection was reduced to minimal. The ethical issue here lies with the health and welfare of the donor cat and the fact the donor can’t consent to its healthy organ being taken.
Answering the question “how far is too far?”, Stephen King’s classic 1989 film Pet Sematary is available to buy from www.amazon.co.uk
In the US, donors are often cats from rescue shelters and the recipient cat not only gains a new organ, but also an adopted friend who will come to live with them after the surgery. I think this is an excellent compromise on the consent dilemma – both cats get a second chance at life.
But it is not just the ethical question of whether we should perform such surgeries on our pets, we also have to consider the practical aspects of these procedures (i.e whether we could carry them out if we decided it was ethically acceptable).
There will be a limited number of vets with sufficient surgical experience to attempt such innovations, especially if a certain type of procedure has never been attempted in a particular species yet (such as Oscar’s legs). Financial constraints are also extremely relevant – owners that would love to give their animals the chance to receive such surgery if needed may be limited by the cost that comes with them.
Personally, I think the work of the surgeons at Fitzpatrick Referrals is exceptional and a real inspiration to vets across the country. I would love to see the day that treatment options for our animals routinely match those available in human medicine, and really hope the work of Noel and his team encourages those interested in such developments to continue and further research in order to make it a possibility – within ethical limits, of course.
The most effective method of vitamin B12 supplementation is by injection.
Cats with inflammatory bowel disease (IBD) may have concurrent low vitamin B12 levels (Tams, 2014).
A case recently presented with a history of chronic intermittent vomiting, inappetence and mild weight loss. Routine biochemistry, haematology, fPL (feline pancreas-specific lipase) and faecal analysis did not reveal any abnormalities, but having recently acquired the cat, the owners were reluctant for any invasive procedures.
Trial therapy with antibiotics, a short course of steroids and a novel protein diet produced some response. Trial therapy with weekly vitamin B12 injections for six weeks, then twice weekly for three months, produced a beneficial response.
The cat has a good appetite, has gained weight and has not vomited for the past month (compared to twice a week prior to therapy). Tams recommends monthly ongoing vitamin B12 therapy.
Reference: Tams T R (2014). Inflammatory bowel disease and lymphoma in cats, Proceedings of the North American Veterinary Conference, Gainsville, Florida: 1,492-1,501.
Peripheral neuropathy is the most common chronic complication of diabetes in cats.
This degenerative disorder typically affects the hindlegs, causing weakness, loss of coordination, inability to jump and a plantigrade stance.
No specific therapy for peripheral neuropathy in cats is available, but intensive blood glucose control decreases the risk and improves clinical signs in humans.
Similarly, aggressive adjustment of insulin therapy may improve nerve function and reverse hindleg weakness and abnormal stance in diabetic cats. However, a cat’s response to the therapy varies and aggressive insulin management can, of course, increase the risk of hypoglycaemia.
