I recently had a male cat presented that was “just a bit quiet” – it wasn’t moving much and, uncharacteristically, had not eaten breakfast that morning.
The owner had barely removed our feline friend from the carrier when I thought: “This guy’s got a blocked bladder.”
Abdominal palpation confirmed my intuitive diagnosis.
I’ve been thinking about this a lot recently – what does it mean? Am I just getting old and have a subconscious feel for what’s coming in through the door?
Then I heard a programme on Radio 4 (that confirms my age!) that said “gut feelings” were actually learned behaviour, and were your subconscious popping ideas into your conscious brain.
So my tip would be to go with those hunches – you might just be right!
Itchy Charlie by Dan Boldy [CC-BY-SA-3.0], via deviantART.Given my interest in dermatology a lot of itchy canine and feline individuals are passed in my direction.
They often have a history of recurrent microbial skin infections either in the form of Staphylococcal pyoderma or Malassezia dermatitis, which is treated as and when it occurs.
I’m often surprised to find these individuals are not receiving routine parasite control, even when many of them have been prescribed it (sadly it is not effective while still in the packet), particularly as we do have both lungworm (Angiostrongylus vasorum) and Sarcoptes about in our practice locality.
My tip would be start to look for the underlying cause when these patients keep coming back – starting with Sarcoptes (and I personally prefer the blood test because I rarely find mites on scrapings).
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.
“Canine Atopy” with dermatitis around the eye, caused by rubbing. Via Wikipedia Commons.
My colleagues and I use immunotherapy on a fair number of dogs to treat atopic dermatitis. Research tells us it can be a valuable tool in some dogs, but at the same time up to a third of dogs respond poorly.
We are lucky in our practice as anecdotally we find the majority of dogs do well, and we only get 10% to 15% that do not respond. This may be because:
We are really hot on parasite control in our practice – we have a large urban fox population and see cases of angiostrongylosis – so we advise Advocate on a regular, monthly basis. So it is unusual for us to see atopic dogs that flare due to concurrent parasite infestation.
We strongly advise owners to do and/or preserve with food trials – and some, okay, just one or two, do respond and relapse on challenge.
We also try to make sure we keep the perpetuating factors, for example, pyoderma and Malassezia dermatitis, to a minimum with medicated wipes and shampoos.
The older the dog when it starts immunotherapy the less likely it is to respond and we advise our owners accordingly.
Good luck with those frustrating allergy cases – hopefully there are some tips here to help. And cats also do well on immunotherapy.
All too often the deciding factor in an animal’s veterinary treatment is cost.
It has to be a factor because there is no NHS for pets. But it is unfortunate that, when undertaking the care of an animal, many people underestimate this cost or even seem to give it no consideration at all – although this is a crying shame because, in an ideal world, welfare should always come before cost. The truth is that it often doesn’t.
Countless times on placements I’ve seen owners arrive in an expensive motor, or flash a handbag worth more than my own car, and yet grumble about the cost of treatment for their pet. However, I was pleasantly surprised by the total selflessness of one particular client I had the gratification of meeting recently.
From appearance (and sadly smell) this client evidently doesn’t have much in the way of spare cash, but comes into the practice frequently throughout the year to add what money is around to their account, ensuring they are always in credit.
This client owns numerous cats, every one of which is up to date with vaccinations, worming etc and receives any other veterinary attention as and when required, despite that none of them are insured.
During one consultation, the vet asked what food the cats all eat, to which the client answered “Sheba”.
As one of the premium brands on the market, this came as a surprise, but cemented the notion that this client really does put their animals before themselves and will provide nothing less than the very best for them.
It was so refreshing to meet someone who genuinely prioritises their pets over anything material in their life – and while this client is an extreme example of dedication to animals, there are other clients who will do all they can with the funds they have for their animals.
The unfortunate reality that so very few people have this mentality can often be disheartening and enraging, but it is the clients that really care and genuinely put their animals first that make the less grateful ones bearable.
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.
I was called out around 11pm recently to a case of acute onset dyspnoea in a seven-year-old Siamese cat (yes, we do our own out-of-hours work – how weird is that?)
Even with my ageing ears, I felt I could hear a crackling over the lung fields and a cardiac arrhythmia. Its mucous membrane colour was a poor grey and it had a body temperature of 35.9°C.
Obviously, the cat’s owners were very keen to know exactly what was wrong, but I really felt any attempts at handling and investigation would tip it into crisis.
Following a good 20mg IM dose of furosemide, some oxygen supplementation and warmth, by the following morning we had a different, happy cat.
My colleague (who is a whizz with an ultrasound) confirmed the cat, Hugo, had hypertrophic cardiomyopathy and was in congestive heart failure, but was doing well with treatment.
I cannot help but reflect that, in my early days, I might well have rushed to investigations in the middle of the night – perhaps with a very different outcome.
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.
I recently had a male cat presented that was “just a bit quiet” – it wasn’t moving much and, uncharacteristically, had not eaten breakfast that morning.
