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Tag: feline

  • Immunotherapy in cats

    Immunotherapy in cats

    Although “off-licence”, immunotherapy is well worth considering in our pruritic feline friends.

    Feline head pruritus secondary to food allergy
    Feline head pruritus, a result of food allergy. Image by Caroldermoid. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

    Of course we need to rule out all other causes of pruritus first:

    • Ectoparasites: As well as all the usual suspects, don’t forget Demodex can occasionally cause ventral alopecia and pruritus (that’s the funny flat form, not the cigar shaped one).
    • Food allergies: Let’s face it, food allergy is tricky to pursue in cats – and if they have a partly outdoor lifestyle, hypoallergenic diets are of not of any use.

    Case study

    I recently saw a case that had typical excoriation lesions around the head and neck.

    The owner was able to keep the cat indoors on Purina HA Hypoallergenic for six weeks, and was happy to dose monthly with Stronghold. This, together with a good response to steroids, was highly suggestive of atopy.

    Serum IgE testing produced a range of high levels to pollens, house dust mite and moulds.

    Our friend has recently started on immunotherapy injections and is now starting to show signs of a good response. With the feline response to immunotherapy reported to be higher than that in dogs, this may be something well worth considering in cats.

  • Don’t talk to clients about free T4 evaluations

    Don’t talk to clients about free T4 evaluations

    Free, not gratis!
    Free, not gratis – image ©iStock.com/Aquir

    We recently had an elderly cat that presented with typical signs of hyperthyroidism.

    However, as is sometimes the case, total T4 proved stubbornly normal on two estimations a couple of weeks apart.

    So we suggested it would be a good idea to send a blood to the lab for free T4 estimation – and you may be able to guess what’s coming next…

    But, you said…

    Yes, you’re right – the client then complained profusely that they had to pay for the test, because (and I quote): “You said it was free!”

    We now call this an “unbound” thyroid blood test – it just makes life simpler.

  • Judging the severity of heart murmurs in cats

    Echocardiography of Hypertrophic-obstructive cardiomyopathy (HOCM) in a cat.
    Echocardiography of hypertrophic-obstructive cardiomyopathy (HOCM) in a cat, by Kalumet [licensed via CC BY-SA-3.0].
    It is harder to correlate the grade of a heart murmur with the severity of the underlying heart problem in cats than it is in dogs.

    Some quite loud murmurs may occur with relatively small defects.

    It is sensible to assess the patient for clinical signs that would suggest an underlying problem (e.g. lethargy, abnormal breathing pattern or effort, pale gums).

    The presence of such signs indicate further diagnostic work up such as echocardiography.

    However, if the cat appears very well, is showing no other clinical signs of a problem, and exercises normally, then it is fair to suggest a repeat examination in a few months to reassess the heart murmur and see if it has changed, or to see if the cat has developed any other clinical signs.

  • Mouth rinses for cats

    Most effective are the chlorhexidine based rinses.

    Say "Aaaah"
    Say “Aaaah”

    Chlorhexidine gluconate is an antiseptic which reduces inflammation and bleeding of the gums and freshens the breath. It has no known side effects.

    Chlorhexidine acetate is antibacterial, but there are some reports of staining of the teeth after prolonged usage.

    Rinses may also help reduce plaque and calculus formation. They can be added to the drinking water or some come with handy applicators, enabling direct application to the mouth.

    When bleeding and inflammation subside, the rinse should be stopped.

    Ideally, daily brushing with cat toothpaste is the gold standard for ongoing dental care.

  • Phosphate levels in chronic kidney disease

    Phosphate levels in chronic kidney disease

    Cat Drinking from tap
    Diagnosing CKD before the appearance of clinical signs is difficult, as no symptoms will be seen until approximately 70% of renal function is lost. However, common signs include increased thirst (polydipsia) and excessive urination (polyuria).

    The overall aim is to maintain the phosphate concentration in the lower end of normal range: <1.45mmol/l.

    IRIS (International Renal Interest Society) specify exact targets for each stage of CKD (two months post-start of treatment).

    CKD Stage 1:  0.81-1.20
    CKD Stage 2:  0.81-1.45
    CKD Stage 3:  0.81-1.61
    CKD Stage 4:  0.81-1.94

    For all cats with CKD, the vet and owner should aim to:

    • increase the cat’s fluid intake
    • manage the diet with renal diet and/or phosphate binders
    • restrict phosphorous, which will improve quality and quality of life
    • use anti-hypertensive treatment if cats have increased blood pressure
    • consider ACE inhibitors in cats with proteinuria (UPC>0.4)
    • employ symptomatic treatment of any other complications

  • Hyperthyroidism and UTIs

    Cystocentesis
    Image courtesy Sarah Caney.

    Cats with hyperthyroidism are more vulnerable to bacterial UTIs. One study reported bacterial lower UTIs were diagnosed in 12% of hyperthyroid cats.

    Bacterial UTIs are clinically “silent” in a high proportion of older cats, with no haematuria, dysuria, or other signs to indicate their presence.

    Where possible, bacterial culture of cystocentesis-obtained urine samples (right) is recommended in hyperthyroid cats at time of diagnosis and periodically thereafter, especially if indicated by clinical signs or previous history.

    Urine bacteriology twice yearly is a good idea.

  • Lungworm in cats

    Lungworm in cats

    Capillaria aerophila in the trachea of a fox
    Capillaria aerophila by Lalošević, V., Lalošević, D., Čapo, I., Simin, V., Galfi, A. & Traversa, D. [CC-BY-2.0], via Wikimedia Commons
    Capillaria aerophila and Aelurostrongylus abstrusus are two of those most commonly found lungworm in cats.

    Cats become infected with lungworm when they drink water or eat prey infected with the larval stage of the worm.

    The larvae migrate out of the intestines via the bloodstream to the lungs, where they develop into adult worms and lay eggs in the host’s lungs within 40 days. The eggs are then coughed up by the cat or passed in faeces, which may then be eaten by birds, rodents and/or snails.

    Symptoms include coughing, dyspnoea and mucus accumulation.

    Treatment options include fenbendazole, albendazole, ivermectin, praziquante and levamisole. Usually, a 10-day course of fenbendazole with three to four days of ivermectin will clear the infection.

  • Ticarcillin as a treatment for Pseudomonas otitis

    Pseudomonas aeruginosa otitis externa
    Greenish purulent discharge accompanied by crusting, erythema and punctuate ulcerations in a crossbreed affected by Pseudomonas aeruginosa otitis externa, secondary to an adverse drug eruption. Image source: Veterinary Times 45.01 (Jan 6, 2014) – “Otitis: a diagnostic approach” by Filippo De Bellis.

    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.

  • Using PDS to “wire” mandibular symphyseal fractures in cats

    We have now started to use Polydioxanone (PDS) to stabilise symphyseal fractures in cats. We use 4 metric PDS passed under the mandible and around the canines in a figure of 8.

    In uncomplicated fractures, we have found this to be really effective and the fracture will heal within four to six weeks. If, like me, you have ever had trouble removing the wire at this time (see video below for example of a traditional wiring method), this technique may well be for you – not to mention the cat will not need further anaesthesia.

    Video: Avulsion fracture of the lower lip and the mandibular symphysis in a cat. Source, YouTube.

  • The view from the other side

    tom-owned-by-jordan
    Tom.

    A recent weekend at home comprised a much-needed rest and time spent with my family – which, of course, includes the animals.

    Tom, my moggie farm-born cat (who is far more scared of any potential prey than it would be of him, so doesn’t really live up to his farm origins), has an allergic skin condition that usually gets worse during the winter months. However, his most recent flare-up was worse than usual, so I took him to the practice I undertook EMS with over the summer and found myself on the other side of the consult table – as the client.

    Having primarily taken him in for his skin, the vet prescribed a short course of corticosteriods to reduce the itching, as I had anticipated.

    However, upon physical examination, it was discovered that Tom had lost weight and had a 3/5 heart murmur.

    It wasn’t until the vet said she could possibly feel a thyroid nodule that the penny dropped – at home Tom continuously cries for food and has a constantly “on edge” demeanour (he’s practically scared of his own shadow).

    This, along with him being an older cat (14 years old), makes for an almost textbook case of hyperthyroidism – so we decided to monitor his weight over the next couple of months and take T4 blood tests if he continues to show a loss.

    It can be easy to become frustrated with clients who omit information that could be vital [...], but I think I’ll be able to sympathise much more in the future.I felt a bit guilty for not realising thyroid could be at play. However, Tom has always cried for food, so I’d never noticed a particular increase in that behaviour – nor had I realised he’d lost condition. Hopefully, this is not because I’m a poor excuse for a vet student, but because gradual changes can easily go unnoticed, which underlines the importance of recording figures for parameters such as weight.

    It can be easy to become frustrated with clients who don’t notice these sorts of things, or omit information that could be vital but they might consider irrelevant. But, having now experienced this myself while understanding the position of both the vet and the client, I think I’ll be able to sympathise much more in the future.