Cats, particularly long-haired varieties, can be carriers of ringworm but show no clinical signs at all.
Diagnosis in the absence of skin lesions is made by either Wood’s lamp over the entire body (only 50-60% of positives will fluoresce), or by taking coat brushings and incubating the hairs, follicles and debris in a dermatophyte test medium (DTM).
Once a cat is diagnosed as a carrier, treatment is the same as for those with lesions: oral itraconazole.
Even after consecutive negative results, the cat should always be considered a carrier, as it’s so difficult to eradicate ringworm from the environment. Treatment is still considered worthwhile, however, and effective cleaning will reduce/prevent further outbreaks.
The “suck it and see” approach can be perfectly reasonable depending on the situation. Photo: Freeimages.com/T.Rolf
“Prognose, prognose, prognose” is a phrase uttered regularly by a vet I’ve spent a lot of EMS and pre-uni work experience with.
Anyone would think he’s trying to drive the point home.
But it makes a lot of sense: although we have myriad diagnostic tests available to us, they won’t always give us a definitive answer, and the owner of an animal, for whatever reason, will often choose the option of “we’ll try this and see” before resorting to getting a clear answer, if necessary.
Suck it and see
Although many vets (and future vets) are perfectionists by nature who would, ideally, want to establish exactly what’s going on before throwing anti-inflammatories (for example) at an animal, it’s not always possible or cost effective to do that – and that is something we have to accept.
The “suck it and see” approach, however, can be perfectly reasonable, depending on the situation.
In my vet’s words: “half the time I haven’t got a bloody clue what’s going on” – and that’s okay. You can’t always get to the bottom of why and what is occurring in your patients, but symptomatic treatment is often both a reasonable and successful approach.
His advice is that you don’t necessarily need a diagnosis, but you MUST give a prognosis. You must forecast what you expect to happen with the treatment given (and give time frames) and inform the client that if there isn’t a marked improvement, if things go backwards or the disease process/condition behaves in an unexpected way, they must bring the animal back for reassessment ASAP. That way, the client has the responsibility to judge for themselves whether something more needs to be done.
Red light green light
This vet also promoted the use of a simple “traffic light” system, through which you decide – on a case-by-case basis – whether you’d rate them a “green, amber or red”.
Green – you know exactly what is wrong with the animal, you have treated accordingly and expect if to make a recovery (or, in the case of things like diabetes or atopy, can manage the condition successfully long term).
Amber – you don’t really know what’s going on, but it isn’t immediately life-threatening and diagnostic tests aren’t urgent at this stage. The “suck and see” approach, by treating symptomatically or “just letting it run its course”, is appropriate for these patients (e.g. an unexplained episode of vomiting or diarrhoea).
Red – not necessarily life-threatening but the patient needs diagnostic tests ASAP or admitting to the surgery for supportive/palliative care (e.g. suspected parvo, 10/10 lameness).
This simple system helps students (and vets) assess the severity/urgency of conditions seen in the consult room there and then, whether they have a diagnosis or not.
Importantly, he also said you can’t have two “ambers” in a row – if a patient sent away with symptomatic treatment returns a week later with no improvement, you must take further action and start testing.
There’s a limited amount that can be done in a 10-minute consult and the key is to be able to make a quick judgement on what the next step is during that time.
Even if you don’t have a diagnosis, prognose, prognose, prognose!
Low-level laser therapy (LLLT) is a rapidly growing adjunctive therapy in companion animal practice.
Low-level laser or cold laser therapy is a non-invasive procedure that uses light to stimulate cell regeneration and increase blood circulation, thus helping damaged tissue to repair.
LLLT can be used to treat dogs with arthritis, tendon or soft tissue injuries, and to promote wound healing.
Most lasers are programmable to a range of frequencies in order to treat many different types of problems in dogs.
It’s always a real pleasure welcoming new graduates to our practice team, and we have been very privileged to employ two excellent vets in the last couple of years.
As well as regular coaching sessions, we’ve also introduced an informal mentoring arrangement with an experienced (non-management) veterinary member of our team. This is very informal and what goes on – other than knowing they meet fairly regularly – I have no idea.
However, the feedback I’ve received is positive from both parties and, with the now-increasingly documented challenges faced by new vets in developing professional skills in their early years, this will hopefully go some way to helping.
Consider routine ear cleaning in chronically waxy ears.
When I attended the North American Veterinary Conference back in January, I was surprised to hear one of the dermatologists say he did not recommend cleaning ears [in chronic cases].
That being said, I’ve heard other specialists espouse the virtues of routine cleaning from upon high.
I’m a great believer in the rule of “if it ain’t broke, don’t fix it”, but I do see atopic dogs that develop significant build up of wax – and routine cleaning with my favorite ear cleaner twice weekly just keeps the use of prescription drugs to a minimum and increases the interval between flare ups.
So, my tip for this week would be to consider this in certain cases.
Despite expecting a purely equine placement, I’ve had a bit of a crash course in camelids over the past two weeks.
As alpacas and llamas continue to increase in popularity throughout the UK, more and more first opinion vets are having to apply their knowledge from other species to these slightly odd creatures.
Having had no previous experience with either of them, even just handling and trying to read their behaviour was a bit of a challenge.
Being social animals who get extremely upset when alone, one in-patient (a llama) was accompanied by two of his friends to minimise stress levels.
Sadly, said llama didn’t make it, but his acquaintances were able to travel home together, considerably less stressed than a lone llama forced to leave its dead friend behind.
Drugs done different
I also accompanied two of the vets to go and castrate eight alpacas, which thankfully went smoother than expected. In addition to learning the procedure itself – which is very similar to castrating a dog, apart from leaving the incision open and only using local anaesthetic – I learned how some drugs must be used differently in these animals. For example, lidocaine has to be mixed with sterile water rather than used straight.
Luckily, we had plenty of help and most people involved were experienced handlers, which made the whole operation run fairly smoothly, even if everyone did get splattered with blood and alpaca spit.
I found out the hard way that alpacas have extremely powerful legs and sharp claws, having had one narrowly miss my face but leave a considerable scratch along my neck, and another tear straight through a pair of very hardy waterproof trousers, in addition to leaving me with numerous bruises.
The point of an alpaca
What’s the point of an alpaca?
Having also been to castrate a llama that day, this sparked a discussion about the purpose of camelids in this country.
Llamas are sometimes kept as guard animals for flocks of sheep, and alpacas for their wool – but, other than being expensive pets or “field ornaments”, what is the end market for breeders?
A breeder present for the mass emasculation expressed his support for castration since, as the popularity of these South American natives grows, so does the number of unwanted individuals.
This discussion on the welfare of unwanted animals reminded me of Princess Anne’s suggestion that a UK horse meat market would decrease the number of unwanted horses.
Could the same be said for camelids? Would an alpaca meat market in this country help the problem, and would it ever take off anyway? Being a very lean meat, I think there could be a market in a nation of people yearning for a healthy lifestyle.
Having visited South America in 2013, I’ll admit I was more inclined to try alpaca steak than another of their native dishes – and believe it far more likely to take off in the UK than guinea pig.
VBJ editor James Westgate speaks to Niall McFerran about the advantages of selling own-brand products from your veterinary practice and how working with The Soft Chew Company can make this a reality.
As well as my veterinary role, I also work part time for the Open University Business School, tutoring the first year of its master’s degree in business administration (MBA).
I recently attended a staff event and thoroughly enjoyed chatting to the academic staff there. However, I couldn’t help but reflect on the fact I was introduced as “Graham the vet” rather than as a tutor – evidence of the high esteem of our profession perhaps?
On another note, I recently came across three acquaintances who have left the profession, which I personally think is sad, but it has to be said they all seem very happy with their choice.
My point here is that, as much as I love being in veterinary practice, I also really love tutoring and I think it has contributed to my wellbeing. So my personal top tip here would be to enjoy doing something non-veterinary too. Perspective is great!
Time for a controversial one, I feel… I have three dogs, and other than those they manage to scavenge in the park, I won’t let them have bones!
For those of you preparing to type away and tell me how wrong I am to advocate such a thing, this tip is based on one of the hardest cases I’ve dealt with in my 25 years as a vet, which involved a lamb bone lodged in the distal oesophagus.
This incident was several years ago and, thankfully, our friend is now doing fine, but it was incredibly traumatic for all concerned at the time.
As I type this I am waiting to see a dog that is straining to pass fragments of bone and is in a lot of discomfort.
So, go on – tell me how wrong I am, and give me all the evidence-based medicine that you should…
Wildlife veterinary medicine is more than being a good shot with a dart gun and knowing what anaesthetics to fill the darts with.
I know this because I was part of a group from Glasgow vet school that visited the Shamwari Game Reserve in South Africa to find out exactly what wildlife medicine entails.
Minimal intervention
Generally, as the animals on the reserve are considered wild, the main aim is to keep veterinary intervention to a minimum.
The majority of the veterinary work is translocation (involving mainly sedation and/or anaesthesia) but there are a few exceptions, which are often dealt with in the reserve’s rehabilitation centre – particularly if the animal in question is rare or highly valuable.
Although we learned a lot about anaesthetics (which was surprisingly easy to relate to practice at home), there’s far more to it than meets the eye.
In-depth knowledge
During our two-week stay we learned that an in-depth knowledge of animal behaviour, among other aspects of conservation, is the vital foundation of the veterinary work.
For example, the length of time an animal will spend in transit and whether the animal will be woken up in the field will have an impact on drug choices – a prey animal needs a complete and rapid recovery in the field to avoid showing weakness to the herd or any predators in the vicinity, whereas an animal travelling halfway across South Africa would require longer lasting sedation.
Species differences are also important to consider; drugs that are highly dangerous in some animals may be the sedative of choice in others.
Additionally, the reaction to being darted needs to be carefully evaluated in terms of both the animals’ and the staff’s safety. We were particularly aware of this when working with buffalo and having to judge the right amount of sedation reversal to allow them to wake up completely, while giving ourselves enough time to dash into the truck and put a safe distance between us before they did so.
A different perspective
The team at Shamwari were eager to give us a practical, hands-on experience – which was great.
Image courtesy Shamwari Conservation Experience.
Not only was it an awe-inspiring couple of weeks, but it was also incredibly useful in terms of consolidating knowledge and practical application of pharmacology – particular anaesthesia.
Experiencing all aspects of conservation in addition to the veterinary work also gave a different perspective to veterinary medicine.
It was exhilarating to be working with such beautiful and potentially dangerous animals – I could certainly feel my heart going through the roof when taking blood from a lion whose snores sounded suspiciously like growls.
