scott@vtx-cpd.com

Replying to Kristin Herstad 03/05/2024 - 14:49

Kristin,

Thank you so much for your brilliant comments and suggestions. It is important to note that no obvious orthopaedic abnormalities were noted, but discomfort reported when palpating the quadriceps muscles suggests a possible muscular issue. The palpable femoral and peripheral pulses indicate normal peripheral circulation.

Given the indoor status of the cat and the absence of typical risk factors for certain diseases, your focus on less common causes such as toxoplasma, cryptococcus, and FIP is appropriate. Running CK and AST for myositis markers, as well as performing radiographs of the chest and ultrasound of the abdomen, are sensible next steps to further investigate potential causes.

Your plan to sample the anterior chamber of the affected eye for cytology and rtPCR for FIP is a brilliant suggestion. However, we were not brave enough to proceed with this step at this time. Similarly, we did not perform serum protein electrophoresis due to increased globulins, but this was also a great suggestion. These tests could provide valuable insights into the underlying cause of the cat’s condition.

Initiating treatment for dehydration and providing nutritional support are crucial steps to stabilize the cat’s condition. Continued monitoring and further diagnostic tests will be essential to confirm a definitive diagnosis and guide appropriate treatment. Great job!

These were the results of the investigations we performed:

Creatine Kinase: Elevated at 1020 U/l (Reference interval 50 – 200 U/l).

Urine protein-to-creatinine ratio (UPCR): Non-proteinuric with a value of 0.1 (Reference ranges: Non-proteinuric: 0.0 – 0.2, Borderline proteinuric: 0.2 – 0.5, Proteinuric: > 0.5).

Urine culture: No growth.

FIV/FeLV ELISA: Both negative.

Blood pressure: Systolic blood pressure of 130 mmHg (measured by Doppler).

Total thyroxine: Total T4 levels within normal range at 30 nmol/L (Reference range: 10 – 60 nmol/l or 2.3 µg/dl Reference range: 0.8 – 4.7 µg/dl).

Coagulation profile: Within normal limits with PT of 12 sec (Reference range: 8.0-15.0 sec), aPTT of 18 sec (Reference range: 9.0-20.0 sec), and D-Dimers of 0.08 mg/L (Reference range: 0-0.56 mg/L).

Toxoplasma serology (Immunofluorescence): IgG positive at 1/512 (Reference range: < 1/32), IgM negative (Reference range: < 1/16). Feline Coronavirus serology: Negative. Thoracic point of care ultrasound (TPOCUS): Presence of free fluid in the pleural space, no B lines evident, left atrium-to-aorta ratio of 1.4. Echocardiography: Unremarkable, no evidence of structural heart disease. Abdominal ultrasound: No free abdominal fluid, unremarkable findings. Thoracic radiography: Identified pleural effusion, unable to evaluate heart and lungs due to the effusion. Thoracic radiography (after thoracocentesis): Revealed a 3cm x 2cm soft tissue mass lesion in the left caudal lung. CT: Thorax, abdomen including hindlimbs: Identified a mass lesion in the left lung lobe, no abdominal abnormalities, and mass lesions in the hind limb musculature. Hindlimb radiography: Showed bilateral soft tissue swelling of the quadriceps muscle. Hindlimb ultrasound: Identified bilateral mass lesions with small fluid pockets in the quadriceps muscle, Doppler examination showed no abnormalities. Pleural fluid analysis: Revealed modified transudate. FNA lung mass: Cytology consistent with epithelial neoplasia with features of malignancy (carcinoma, highly likely) and suppurative inflammation. FNA hind limb masses: Cytology consistent with epithelial neoplasia with features of malignancy (carcinoma, highly likely) and suppurative inflammation. Intraocular pressure: Normal. Thank you again for your brilliant reply! Scott 🙂

Replying to Nichola Healey 03/05/2024 - 20:54

Hi Nichola! Welcome to the course! It’s great to hear about your background and your commitment to keeping up with industry knowledge. We’re glad to have you here and hope you find the topics and speakers engaging and informative. If you have any questions or need any assistance along the way, feel free to reach out. Enjoy the course and getting stuck into the material!

I’m curious, since you’re still working within the industry, could you share which part you’re currently involved in? It’s always fascinating to hear about the different paths people take after their clinical work.

Scott 🙂

Replying to Rodolfo L. 06/05/2024 - 07:59

Hi Rodolfo,

Thank you for the warm welcome! I’m excited that you’re part of the course too and I’m looking forward to learning from you.

Best wishes,

Scott 🙂

Replying to Laura S. 06/05/2024 - 16:09

Hello Laura!

Thank you so much for joining us, we really appreciate the support!

Welcome back to practice after your maternity leave! The veterinary medicine is the easy part of life with kids around! 🙂

Let me know if you have any questions.

Scott 🙂

Replying to Felipe M. 06/05/2024 - 18:27

Really helpful!

Thank you for sharing your wisdom!

Scott 🙂

Replying to adele smart 01/05/2024 - 18:15

Also…

I love this profile picture Adele!!!

Can we talk about ferret respiratory disease?

Scott x

Replying to Talia C. 30/04/2024 - 16:03

Dear Talia,

I’m glad you found the information helpful.

Regarding buprenorphine dosing, it’s understandable to be cautious about higher doses, especially in older patients. The dose you’re using is within the typical range for buprenorphine, and if it’s working well for your patients without causing significant sedation, that’s great. Simbadol (buprenorphine extended-release) can be a useful alternative, particularly for cats, as it provides longer-lasting pain relief with a single injection.

Pregabalin can be a useful option for chronic pain management in cats and dogs, although its use in cats is less common. I personally haven’t used pregabalin in cases, but I have often used gabapentin. Pregabalin may have some advantages over gabapentin in certain situations, so it’s worth exploring further, especially considering your positive experience with it in dogs.

For Burnis, it’s good to hear that his liver enzymes are within normal limits. Since he seems to prefer the Intestinal diet and his clinical signs are not severe, it’s reasonable to continue with that diet as long as he’s doing well on it. Monitoring his urine and considering cholecystocentesis if his abdominal discomfort persists are good next steps. The cost of the liquid formulation of prednisolone is unfortunate; it’s a common issue with compounded medications.

It sounds like you have a thoughtful plan in place for Burnis’s care. If you have any more questions or need further guidance, please don’t hesitate to ask. I’ll also reach out to Felipe or an anesthesia specialist for their insights on using pregabalin.

Best regards,

Scott 🙂