scott@vtx-cpd.com

Hi Sarah! 😊

Great questions, pancreatitis in Miniature Schnauzers can definitely be a tricky topic!

1. Predisposition to Pancreatitis in Miniature Schnauzers:
Miniature Schnauzers do have a known predisposition to pancreatitis, primarily related to their increased incidence of idiopathic hypertriglyceridemia. Elevated triglyceride levels can directly contribute to pancreatic injury through lipotoxicity and the formation of toxic byproducts during lipid metabolism, which damage pancreatic tissue and initiate inflammation.

That said, it is worth noting that Miniature Schnauzers may also have an independent predisposition to pancreatitis unrelated to hypertriglyceridemia. Genetic studies have not conclusively linked specific mutations (e.g., SPINK1 variants) to pancreatitis in Schnauzers, but their breed-specific metabolic and pancreatic characteristics likely play a role. Additionally, dietary factors, obesity, and concurrent conditions like hypothyroidism or diabetes mellitus can exacerbate their risk.

2. CRP in Chronic Pancreatitis:
C-reactive protein (CRP) is a well-established marker for systemic inflammation and is typically elevated in acute pancreatitis (AP), correlating with disease severity. However, its role in chronic pancreatitis (CP) is less clear. Chronic pancreatitis often involves low-grade, ongoing inflammation and fibrosis, which might not provoke as significant a CRP response as acute inflammation.

That said, CRP could still be mildly elevated in cases of active or acute-on-chronic pancreatitis episodes, where there is a surge in inflammation. Studies have shown a correlation between CRP levels and clinical disease activity, so it can be a useful adjunct marker to assess disease progression or flare-ups, particularly when paired with cPLI and imaging findings.

It sounds like you’re managing a complex case. If hypertriglyceridemia is a factor, managing lipid levels (e.g., through diet or omega-3 supplementation) might help reduce pancreatic stress. Let me know if you’d like to discuss further!

Cheers,

Scott 🙂

Hi Rosanna,

Sorry to hear about your wee cat! Sending lots of healing thoughts. The team at Langford will take great care of you. I have tried to pull together information from the resources I have. There is not a huge amount of information out there! Chronic lymphocytic leukaemia (CLL) in cats is indeed rare and poorly understood, but I’ve gathered extensive information to help address your questions and provide context about this condition.

Understanding Feline CLL

CLL is a hematologic neoplasm characterized by the proliferation of small, mature lymphocytes in the peripheral blood, bone marrow, and sometimes other organs. In cats, it is most commonly a T-cell neoplasm, specifically CD4+ T-helper cells.

Key Characteristics:

Signalment: CLL affects middle-aged to older cats, with a median age of 12.5 years (range: 5–20 years) (Campbell et al., 2013). This aligns with your cat’s age. Males are slightly more affected, with a male-to-female ratio of approximately 2:1 (Workman & Vernau, 2003). Domestic shorthair and longhair breeds are most commonly diagnosed, though CLL can occur in purebred cats like Bengals or British Shorthairs.

Presentation: 50% of cases are diagnosed incidentally during routine bloodwork (Campbell et al., 2013). The most common clinical sign is chronic weight loss, reported in 44% of cases. Other signs include lethargy, reduced appetite, vomiting, diarrhea, or unremarkable physical examination findings (Campbell et al., 2013; Workman & Vernau, 2003). Cats are often asymptomatic early in the disease.

Diagnostic Findings: Peripheral lymphocytosis is a hallmark of CLL. In most cases, lymphocyte counts exceed 9,000 cells/μL, with a median of 34,200 cells/μL (range: 9,561–325,477 cells/μL) (Campbell et al., 2013). Bone marrow lymphocyte infiltration (>15–20% of total nucleated cells) is common but not universal. Cytopenias, such as anemia (50%) or thrombocytopenia (11%), are observed in some cases (Workman & Vernau, 2003; Campbell et al., 2013). Biochemical abnormalities are generally mild and non-specific, with occasional hyperglobulinemia or elevated ALT levels. Infectious disease testing (e.g., FeLV, FIV, tick-borne diseases) is typically negative.

Immunophenotyping and Classification

Immunophenotyping and clonality testing (e.g., flow cytometry and PARR) are essential for confirming CLL. Studies show that most feline CLL cases are T-cell in origin (94%), with the majority being CD3+/CD4+/CD8− T-helper cells (Campbell et al., 2013). Rarely, B-cell CLL is diagnosed (6%), characterized by CD21+ malignant lymphocytes (Workman & Vernau, 2003). The use of these techniques ensures accurate diagnosis and helps distinguish CLL from other lymphoproliferative disorders, such as lymphoma or reactive lymphocytosis.

Treatment Recommendations

Treatment decisions are based on clinical signs, lymphocyte counts, and disease progression. In asymptomatic cats or those with mild disease, treatment may not be immediately necessary (Campbell et al., 2013; Workman & Vernau, 2003). Chemotherapy is recommended for cats with significant clinical signs, progressive lymphocytosis (typically >60,000 cells/μL), cytopenias, or organ involvement (e.g., hepatosplenomegaly or lymphadenopathy). The mainstay of treatment is chlorambucil (0.2 mg/kg or 2 mg per cat every other day) and prednisolone (1 mg/kg daily). These medications are generally well-tolerated and effective in inducing remission. For refractory or advanced cases, protocols incorporating vincristine, cyclophosphamide, or other chemotherapeutics (e.g., L-CHOP) may be considered.

Prognosis and Outcomes

CLL is considered an indolent disease in cats, with median survival times of 14.4 months (range: 0.9–25.3 months) reported in one study (Campbell et al., 2013). The overall remission rate for treated cats is 88%, with a median remission duration of 15.7 months. Second remissions are possible, with durations of up to 18.1 months. Treatment-related side effects are uncommon but may include gastrointestinal upset or mild cytopenias (Campbell et al., 2013; Workman & Vernau, 2003). Cats with T-cell CLL typically have a good quality of life during treatment. B-cell CLL is so rare in cats that prognostic differences between the two phenotypes are not well-characterized.

To Address Your Specific Questions:

Life Expectancy: Based on available studies, median survival is approximately 14–17 months for treated cats (Campbell et al., 2013). Many cats achieve complete or partial remission with treatment, and survival can extend beyond two years in some cases. Since your cat is asymptomatic, this may positively influence his prognosis.

Chemotherapy Necessity: Chemotherapy is not always required in asymptomatic cats with stable disease (Workman & Vernau, 2003). A “watchful waiting” approach, with regular monitoring of bloodwork and clinical signs, is often appropriate. Treatment is reserved for cases with clinical progression, high lymphocyte counts, or cytopenias.

Bone Marrow Biopsy: While bone marrow examination is valuable for staging and diagnosis, it is not always necessary if clonality and immunophenotyping have already confirmed CLL (Campbell et al., 2013). Langford’s team can help determine if further invasive diagnostics are warranted.

Comparisons to Human Medicine

In humans, CLL is primarily a B-cell malignancy, characterized by the overexpression of anti-apoptotic proteins (e.g., Bcl-2) and an indolent course (Workman & Vernau, 2003). While feline CLL shares some similarities, the predominance of T-cell neoplasms in cats suggests differing pathophysiology. Unlike human medicine, advanced diagnostic tools like cytogenetics and molecular markers (e.g., ZAP-70) are not widely available for cats.

Summary

Feline CLL is a manageable disease, often allowing for good quality of life. With early diagnosis and appropriate treatment, many cats respond well to therapy. Chlorambucil and prednisolone remain the mainstays of treatment, and remission rates are encouraging. Your proactive approach and Langford’s expertise will ensure the best possible outcome for your cat.

If you’d like further literature summaries or clarification, I’m happy to help. Wishing you and your cat all the best as you navigate this journey!

Key References:

Campbell MW, Hess PR, Williams LE. Chronic lymphocytic leukaemia in the cat: 18 cases (2000–2010). Vet Comp Oncol. 2013 Dec;11(4):256-64. doi: 10.1111/j.1476-5829.2011.00315.x.
Workman HC, Vernau W. Chronic lymphocytic leukemia in dogs and cats: the veterinary perspective. Vet Clin Small Anim. 2003;33(6):1379-1399.

Please keep me updated. Best regards,

Scott 🙂

Replying to Raquel M. 17/01/2025 - 17:54

Hi Raquel,

You’re very welcome! I’m so glad the advice has been helpful, and I appreciate you keeping me updated. Regarding your question about Hill’s I/D Digestive Care, you’re absolutely correct—it is labelled for growth and could be a good alternative if it’s easier to source than Purina HA. Both diets are formulated for GI support and growth, so either would be suitable for Lloyd, depending on availability and owner preference. If Hill’s I/D Digestive Care is more readily stocked on the island, it could simplify things for the owner while still providing the nutritional and therapeutic benefits he needs.

I’d be happy to help draft a protocol and provide materials for your clinic to address acute uncomplicated diarrhea. This can include a clear step-by-step process, evidence summaries, and recommended product options like probiotics and dietary interventions. I’ll prepare something comprehensive that you can present to your colleagues to encourage this positive change. Let me know if there’s anything specific you’d like included, and I’ll make sure it’s tailored to your clinic’s needs.

Thanks again for your thoughtful questions and for keeping me informed about Lloyd’s progress.

Kind regards,

Scott 🙂

This is so interesting!

I never thought we would be discussing a Chinchilla, but very excited we are!

Thanks for sharing.

Scott 🙂

Replying to Rosanna Vaughan 20/01/2025 - 13:17

Let us know how you get on!

Scott 🙂

Hey Rosanna.

Definitely not my are of expertise! I have reached out to some surgeon pals to comment too!

Thanks again for the great question!

Scott 🙂

Hi Josep,

Thank you for your contribution to the neurology course! Neurology is always such a challenge, and I truly appreciate the effort you’ve put into making it approachable. Along with ophthalmology, it’s one of those topics I’ve always found particularly tricky—but I’m excited to dive in and learn from the cases and insights you’ve prepared. I’m sure your guidance will make all the difference.

Looking forward to this journey!

Scott 🙂

Replying to Raquel M. 17/01/2025 - 12:37

Hi Raquel,

That’s fantastic news about Lloyd’s progress! It’s great to hear his stool is normal now. Since he’s currently on a grain-free diet, transitioning him to a more nutritionally balanced option, such as Purina HA, is an excellent next step. This will help him regain weight, improve his body condition score (BCS), and avoid potential long-term effects associated with grain-free diets. For the transition, given his GI history, I’d recommend a 10- to 14-day gradual change to minimize the risk of GI upset. Start by replacing 25% of his current diet with the new food for 3–4 days, then increase to 50% for another 3–4 days, followed by 75%, and finally 100% of the new diet. During the transition, monitor his stool consistency and adjust the timeline if needed.

I also wanted to address your concern about introducing the idea of reducing metronidazole as the first-line treatment for acute uncomplicated diarrhoea, which I completely understand is a sensitive topic as you’ve recently joined the clinic. Evidence increasingly suggests that metronidazole may not be the best option for such cases. Studies show it does not significantly decrease the duration of diarrhoea compared to probiotics or placebo, and it has been associated with disruptions to the gastrointestinal microbiome that can persist for weeks, particularly affecting bile acid metabolism. These microbiome changes can have longer-term implications for canine gut health.

Probiotics or synbiotics, on the other hand, appear to offer comparable or slightly better reductions in diarrhoea duration without the adverse effects on the microbiome. Studies like those by Shmalberg et al. (2019) and Kelley et al. (2009) suggest probiotics can reduce diarrhoea duration by up to 2.5 days in some cases. Moreover, probiotics are generally safe and provide a tangible treatment option for owners who expect medication. Products like Visbiome Vet or FortiFlora could be used to meet these expectations while aligning with evidence-based medicine.

To encourage a shift in clinic practice, you might consider a few strategies. First, sharing educational materials or presenting a brief overview of the evidence could help highlight the risks of overusing metronidazole and the benefits of probiotics as a first-line treatment. Proposing a standard clinic protocol for managing acute uncomplicated diarrhoea could provide a clear and structured alternative. This could include dietary management with GI support diets, probiotics like Visbiome Vet, and deworming with fenbendazole if indicated, reserving metronidazole or other antimicrobials for cases with clear evidence of bacterial overgrowth or systemic involvement.

The available evidence supports probiotics as a safe, effective alternative to metronidazole for uncomplicated diarrhoea and shows that dietary changes and supportive care are sufficient for most cases. If you’d like, I’d be happy to help draft a specific protocol or provide materials to assist in discussions with your colleagues. Let me know how I can support you further with this or Lloyd’s ongoing care!

Kind regards,

Scott