scott@vtx-cpd.com
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Replying to Areti Tsioka 19/06/2021 - 10:29
Hey.
We are still not sure. We have covered with antibiotics (amox/clav) and we have given immunosuppressive doses of steroids to some. Blood transfusion has been necessary for some too.
At the moment it is still not clear if steroids will help.
Scott 🙂
Replying to Nikki McLeod 19/06/2021 - 10:29
I think you will be getting a lot of requests for haematology!
Scott x
Replying to Liz Bode 18/06/2021 - 20:48
Hello again.
Following on from my last post. I have some updated information from the work the RVC are doing:
“Based on the evidence to date, the one aspect of these cases that formed a consistent pattern was the diet of the affected individuals.
Data obtained from the survey so far (June 13th) :
• Number of affected cats: 108 (June 16th – 142)
• Median age at presentation: 2.21 years (IQR 0.75 – 6.15, range 0.08 – 14.92)
• Median duration of clinical signs prior to presentation: 2.00 days (IQR 1.00 – 3.00, range 0.00 – 68.00)
• Most common clinical signs were lethargy (75.9%), anorexia/inappetence (65.7%), pyrexia (34.4%) and signs of bleeding (petechiae – 18.5%; haematochezia 13.9%; oral haemorrhage 13.0% and haematuria 10.2%); vomiting and diarrhoea are not consistent clinical signs
• FIV testing negative in all tested cats (77.8%)
• FeLV testing negative in all tested cats (76.9%)
• Parvovirus testing on bone marrow – positive in one cat (1.5%) and negative in 14 other cases, further testing of samples is pending
• Bone marrow sampling -if performed – revealed 53.6% hypoplasia, 39.3% aplasia – some cats were sampled post euthanasia, and examination of those samples are still pending.
• 44.4% indoor only, 55.6% indoor and outdoor, remaining unknown
• 33.3% from a single household, 66.7% from a multi-cat household, for 65.3% of the multi-cat household both cats were affected
• 55.6% of cats received flea/dewormer, 34.3% no treatment, remaining unknown
• 10.2% were vaccinated within 1 mth of presentation, 88.0% did not receive a recent vaccination, not recorded in 1.8%
• For 75.9% (n=82)of the cats, specific details to diets were recorded, 45.1% of the cats were fed on a dry diet only, 2.4% on wet only, and 52.4% on a combination of dry and fed.
• 69 cats (84.1%) were fed on one of 3 dry dietsGiven this apparent association with diet, we welcome the Food Standards Agency’s (FSA) product recall notice. While we have not definitively established diet as the cause of pancytopenia in these cats, we are continuing to liaise with the pet food industry and regulatory bodies to investigate the matter and identify the possible underlying causes of this extremely serious condition.
We are still very keen to collect epidemiological data +/- residual patient samples and feed samples, so PLEASE continue logging your cases. https://rvc.onlinesurveys.ac.uk/pancytopenia
Initial investigations have not identified a causative agent yet:
• Copper and zinc – unremarkable
• Cobalamin, folate – within reference in majority of cases
• Oestrogen concentration – low in tested animals
• Heavy metals concentration on blood – no lead, though some have a very short half-life in blood, further testing underway
• Post mortem examinations so far have not found any other significant abnormalities beside the bone marrow findings and changes that might result from this; in particular no gastrointestinal, hepatic or renal changes are noted.Further feed analysis is underway currently. The recalled diets are:
Sainsbury’s:
Sainsburys Hypoallergenic Recipe complete dry cat food with salmon 1+years 800g
Sainsburys Hypoallergenic Recipe complete dry cat food with chicken 1+years 800g
Pets at Home:Ava Kitten Chicken 300g and 2kg
Ava Adult Chicken 300g, 2kg and 4kg
Ava Adult Fish 2kg
Ava Mature Chicken 7+ 2kg and 4kg
Ava Senior Chicken 12+ 2kg
Ava Sensitive Skin & Stomach 1.5kg
Ava Weight Management 1.5kg
Ava Hairball 1.5kg
Ava Oral Care 1.5kg
Ava British Shorthair 1.5kg
Ava Persian 1.5kg
Ava Maine Coon 1.5kg
Applaws products (best before date between December 2022 to June 2023 with a site reference code of GB218E5009):Applaws Cat Dry Chicken 400g, 2kg and 7.5kg
Applaws Cat Dry Senior Chicken 400g, 2kg and 7.5kg
Applaws Cat Dry Chicken & Salmon 400g, 2kg and 7.5kg
Applaws Kitten Dry Chicken 400g, 2kg and 7.5kg
Applaws Cat Dry Chicken & Lamb 400g, 2kg and 7.5kg
Applaws Cat Dry Chicken & Duck 400g, 2kg and 7.5kg
Applaws Cat Dry Ocean Fish 350g, 1.8kg and 6kI hope that helps.
Scott 🙂
Replying to Areti Tsioka 10/06/2021 - 16:07
That is really disappointing.
You did all the right things with this case. I think you are right, sounds like there were lots of concurrent issues.
Scott 🙂
Replying to Areti Tsioka 10/06/2021 - 16:09
Yes!
That would definitely exclude it from your list!
Scott 🙂
Sorry for delay!
I will get that uploaded!
Scott 🙂
Replying to Areti Tsioka 15/06/2021 - 12:22
It is a good question!
I think the main issue is that the HDDST is not 100% sensitive or specific, so you could still be left with the question of whether to image.
Imaging these cases is definitely something that I think is worth offering. It can change what we do if owners would consider surgical removal of an adrenal mass or would consider surgery or radiotherapy of a pituitary mass.
If owners are not keen for that then it is still totally appropriate to use trilostane, as it will still deal with the clinical signs regardless of the location of the disease!
Hope that makes sense.
Scott 🙂
Hello.
Lovely to hear from you. I hope you are safe and well. I am sorry about the delay in getting back to you. The new website and all!
What dose is the dog on currently? Would you be able to share most recent bloods and the Freestyle results with me?
Thanks.
Scott 🙂
Hello.
Hope you are well and I am glad that you enjoyed the lesson.
The Rapidexon would be fine. A short acting 2mg/ml dexamethasone would be best.
Regarding which test, it would depend a bit on the case too. In cases that have other illness/sick then starting with an ACTH may be better. I agree that in a case with compatible clinical signs, if the LDDST is not clear I would re-test again in 1-3 months with an ACTH stim or a repeated LDDST.
It is a good question. Honestly not really. It is not full proof and would not change your treatment initially. Even if this was suggestive of pituitary disease it would still be recommended to perform advanced imaging (CT/MRI) before any more definitive treatment.
Does that make sense?
Scott 🙂
HAHAH!
Sounds like you are doing all the right things!
USG is really low and you are right… there could be more than one thing going on:
Tumors of the hypophysis as the cause of both Cushing’s syndrome and diabetes insipidus in dogs
Abstract
Invasive tumors of the pituitary gland associated with Cushing’s disease and diabetes insipidus are described in ten dogs. All patients showed typical clinical symptoms including polyuria/polydipsia and acanthosis nigricans. All tumors led to compression and partial destruction of the posterior lobe of the pituitary gland and the infundibular stalk; two of them infiltrated the hypothalamic region. All tumors produced ACTH and caused hyperadrenocorticism. In six cases, additional expression of beta-lipoprotein and MSH were found: in pars intermedia adenomas many cells stained strongly for MSH and/or beta-lipoprotein, whereas in tumors of the pars distalis only occasional cells stained positive. The purpose of the present study was to describe the neuropathological findings and the immunohistochemistry of hormone excretion in pituitary tumors in dogs resulting in Cushing’s disease associated with D.i., to review the literature and to discuss the pathogenesis.
Hey!
How did things go with this case? This one sounded like a real challenge!
Scott 🙂
Hey.
Hope you are well.
How did you get on with this case?
Scott 🙂
Regardless of all of that, Tessa is totally right!
It really depends on lab. Cortisol measurements can vary… so best to check with them!
Scott 🙂
Lessons are available for 6 months! You have plenty time!
Urinary corticoid excretion, determined from a morning sample, is a reflection of adrenal glucocorticoid secretion over a period of several hours, negating concerns regarding fluctuating blood concentrations. Several studies have demonstrated UCCR as a sensitive screening test (nearly 100%) but with low specificity (20-77%). Due to its sensitivity, UCCR is a good test for ruling out HAC, since a normal result makes the diagnosis extremely unlikely. Since the UCCR is non-specific and increased in dogs with various conditions, further testing is warranted if the UCCR is increased in a dog suspected of HAC. In some studies… dogs with PDH tend to have higher UCCR values than those with FAT and if >100 (reference range, <10), the probability of PDH is 90%.
Scott 🙂
Thank you so much for the kind words regarding the lesson!
I am so glad you liked it.
So sorry about the delay in getting back to you.
Hope you are safe and well.
Scott 🙂
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