scott@vtx-cpd.com
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Replying to Emma Henton 09/09/2024 - 13:31
Hi Emma, welcome!
It’s great to hear you’re returning to practice. Are you enjoying the course so far, and how are you finding the transition back into small animal practice after some time away? Would love to hear how it’s going for you!
Scott 🙂
Replying to Laura Jones 20/09/2024 - 09:56
HAHAHAHAHAHA!
This is true!
Scott 🙂
Replying to Kerida Shook 19/09/2024 - 23:17
No problem.
Keep me posted with the case!
Scott 🙂
Replying to Laura Jones 20/09/2024 - 10:00
It is crazy right!
I did not even realise it was a thing! It was obviously a technicians cat!
Scott 🙂
Hey.
This is indeed a tricky case, but I think you’re on the right track with your suspicions. When considering pleural effusion in cats, especially with the clinical signs you’ve described, the two primary differentials to keep in mind are cardiac disease and neoplasia. However, in younger cats like this, FIP (feline infectious peritonitis) should always be high on the differential list, especially given the presentation of amber-colored effusion, pyrexia, and the elevated globulins.
Cardiac disease can’t be entirely ruled out yet, but based on your description—normal heart rate, strong femoral pulse post-fluids, and no evidence of heart murmurs—it doesn’t appear to be the leading cause. An NT-proBNP test could be useful here to help further rule out cardiac involvement, but it may not be immediately necessary if you’re already leaning towards FIP based on the clinical picture. The improvement in pulse strength after fluids also supports that this may not be primarily cardiac.
The effusion’s high specific gravity (1.035) suggests a proteinaceous fluid, which aligns with the typical findings in the wet form of FIP. This, combined with the high globulin to albumin ratio, persistent pyrexia, and a young neutered male cat, strongly supports the diagnosis of FIP. While awaiting the PCR results from IDEXX, it’s crucial to recognize that these can take several days, and your patient may not have the luxury of time, as they are still showing clinical signs of illness.
Given the cat’s condition and the risk of further deterioration, I believe you are justified in starting presumptive treatment for FIP now, rather than waiting for PCR confirmation. Many clinicians are now starting treatment based on a combination of clinical suspicion and fluid analysis, especially in situations like this where waiting for definitive confirmation could be detrimental to the patient.
I would advise discussing the situation clearly with the owners, emphasizing that while FIP is highly suspected, the treatment is presumptive at this stage. They should be aware of the nature of the diagnosis, the rationale for starting treatment now, and the potential outcomes.
You’re handling a challenging case, but your reasoning is solid, and I believe early intervention is warranted here. Let me know how things progress, and feel free to reach out if more concerns arise as you move forward with treatment.
Best regards,
Scott
Replying to Rachel R. 18/09/2024 - 21:51
Thank you.
Really glad you are enjoying it, and thanks for the great questions/discussion!
Scott 🙂
Replying to Ellen T. 18/09/2024 - 11:54
Hi Ellen,
It sounds like you’re seeing a lot of these cases, and your rationale for withholding antibiotics unless there is evidence of neutrophilia or pyrexia makes sense, especially given the focus on judicious antibiotic use. Neutrophilia or fever tends to indicate a more systemic infection, which could justify antibiotic therapy. In the absence of these signs, withholding antibiotics helps avoid unnecessary use and the potential for resistance.
Regarding cases transferred to you already on antibiotics like metronidazole or co-amoxiclav, I agree that unless there are signs of systemic illness, stopping the antibiotics—especially if the patient is on a combination like metronidazole and amoxicillin/clavulanic acid—would be reasonable. There is no good evidence to suggest that finishing the course of antibiotics is always necessary. If the patient is systemically unwell, sticking with amoxicillin/clavulanic acid alone should usually be sufficient, as it provides broad coverage for most common pathogens. Each case might warrant reassessment, with diagnostics guiding whether to continue or discontinue antibiotics.
Hope this helps, and thanks again for the great question!
Best,
Scott
Replying to Ellen T. 18/09/2024 - 11:58
Great to see you Ellen!
Thank you for joining us. Please let me know if you have any questions, or any cases you would like to discuss.
Scott 🙂
Replying to Karin V. 16/09/2024 - 23:26
No problem.
I am really sorry you had this issue. Glad it is sorted.
Have the best week and let me know if you have any questions.
Scott 🙂
Replying to Amanda-Jane Rogers 17/09/2024 - 10:57
I agreeeeeeeeeeee!!!!!
Massively over used drugs! So interesting how our understanding and use of these drugs has changed over the last 10 years.
What I think is most interesting, is the possible damage we are doing in some cases with these drugs.
Hope you are well.
Scott 🙂
Replying to Laura S. 17/09/2024 - 11:08
Hey Laura.
Great points! I totally get where you’re coming from. Telephone calls can definitely feel more efficient—you get the conversation done in real time, and it feels like there’s a clear start and end. With email, things can drag on, and it does sometimes turn into a back-and-forth that feels endless.
I think you’re spot on about the risk of making ourselves too available. Clients can see email as a way to bypass the system, and managing expectations becomes tricky. I like your idea of having an admin email specifically for photos and videos—that could be a good way to keep things organized and still benefit from the visuals without it becoming overwhelming.
Another major advantage of email for me is that it provides a record of the conversation without needing to manually document it, which is a big plus. I’ve been using dictation software lately to help record phone conversations into clinical records, and that’s been a real game-changer for staying on top of things.
Thanks again for your response.
Scott 🙂
Replying to Karin V. 16/09/2024 - 18:53
Really sorry to hear this.
Will look at this now.
Scott 🙂
Replying to Steph Sorrell 14/09/2024 - 07:24
Hey!
While in-house analyzers are improving in terms of accuracy, it’s wise to exercise caution when diagnosing thyroid disease solely based on in-house results. A convincingly high T4 level that matches the clinical signs can usually be trusted, but for borderline or unclear cases, sending the sample to an external lab is always a good practice. Consistency is indeed key—using the same method regularly helps in monitoring trends over time.
Hope that helps.
Scott 🙂
Replying to Sarah W. 13/09/2024 - 20:20
Hello Sarah.
I hope you are well. Great question!
I will let Steph share her thoughts… I have a few too that I can add!
Have a lovely weekend.
Scott 🙂
Replying to Rachel R. 12/09/2024 - 14:00
Hey Rachel.
Thanks for your brilliant questions.
I have some thoughts, but I will let Steph wade in first!
I hope you are enjoying the course!
Scott 🙂
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