scott@vtx-cpd.com
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Replying to Mairi Frame 06/09/2023 - 21:40
Mairi!
Thank you so much for joining us. We are very lucky to have the opportunity to work with you!
Scott x
Replying to Emma Middleton 05/09/2023 - 10:02
Hey Emma.
Thanks so much for your comments. You are spot on. The cat has hyperadrenocorticism!
Various options are available to address feline HAC, and treatment decisions will depend on the cat’s final diagnosis (i.e., PDH vs ADH), and the owner’s willingness and ability to care for its needs. I think you are right, in this case I would be most suspicious of PDH. It is not unusual for cats with concurrent DM to require substantially less insulin or enter diabetic remission with effective management of their HAC. Options for cats with PDH include medications to suppress adrenal function, radiation therapy, hypophysectomy and bilateral adrenalectomy. For cats with ADH, surgical removal of the affected gland is generally the most appropriate option; medical therapy may otherwise be considered.
Regarding medical therapy, trilostane is probably most commonly used. Trilostane (as Vetoryl; Dechra) is licensed for the treatment of both PDH and ADH in dogs, but has not been approved for use in cats. However, it is widely regarded as the first choice for medical management in this species as it is readily available, generally well tolerated and often beneficial. A starting dose of 10 mg/cat q12h PO is generally appropriate. Although q24h therapy may be adequate in non-diabetic Cushingoid cats, q12h administration ensures that each dose of insulin is ‘matched’ by the same dose of trilostane. Owners should be advised to discontinue the medication if the cat is anorexic or lethargic, as these may be signs of (relative) cortisol deficiency. Owners should be provided with a short-acting glucocorticoid and instructed to administer a dose (e.g., prednisolone 0.5 mg/kg PO) if the cat seems unwell. This will rapidly reverse the signs of hypocortisolaemia and protect again insulin-induced hypoglycaemia. Trilostane doses needed to achieve a significant amelioration of HAC in cats vary considerably, with reported means ranging from 2.7 mg/kg q24h to 10 mg/kg q12h. Outcomes are generally positive, with survival times >12 months routinely reported. Most cats experience a decrease in insulin requirements; diabetic remission appears to be uncommon, but was recently documented in one cat following 7 months of trilostane therapy.
This is a really good open access review:
https://journals.sagepub.com/doi/10.1177/1098612X20979507
Interesting case!
Scott 🙂
Replying to Natalie Niven 07/09/2023 - 17:01
Hello Natalie.
Lovely to see you here. I love that your surgical benchmark is Greys Anatomy… mine too! My cardiology is based on when Izzie cut Denny’s LVAD wire to move him up the UNOS donor register in series one!
I will let Liz answer the actual cardiology questions!
Scott 🙂
Replying to Izabela K. 08/09/2023 - 15:38
Welcome Izabela.
Thank you so much for joining the course.
Please let us know if you have any questions.
Scott 🙂
Hello!
This is a brilliant question! I must admit that I am not routinely including SDMA in every patient that I am investigating for PUPD. It really does depend on the patient. I think there is really no point in running SDMA if the urea and creatinine are significantly increased. I would say that the majority of PUPD patients can be investigated without the inclusion of SDMA, but again, it has its place.
I think this recourse from IDEXX is helpful:
https://www.idexx.co.uk/en-gb/veterinary/reference-laboratories/sdma/interpreting-your-sdma-results/
SDMA is now included in the IRIS guidelines and can be helpful in staging early renal disease:
http://www.iris-kidney.com/pdf/2_IRIS_Staging_of_CKD_2023.pdf
If I was investigating a PUPD patient without another obvious cause, I would consider an SDMA.
Are you using SDMA a lot in practice?
I hope that helps.
Scott 🙂
Replying to Emma Middleton 05/09/2023 - 09:43
Welcome Emma!
Great to see you here and thank you so much for learning with us.
I really hope you find everything useful and we can help with the mojo a bit!
Let me know if you have any questions at anytime!
Scott 🙂
Replying to Loren S. 04/09/2023 - 10:23
Hello Loren and Arthur!
Life will look a lot different now I am sure! I hope you are enjoying the new challenges of parenthood!
Thank you so much for joining the course. I will try and post some feline and endocrine cases!
Let me know if you have any questions at any time.
Scott 🙂
Replying to Ariane N. 31/08/2023 - 14:35
Brilliant!
Thank you so much!
Scott 🙂
This is really interesting Liz.
Thank you for sharing.
Scott 🙂
Replying to Liz Bode 01/09/2023 - 20:28
Thanks Liz.
I was chatting to Poppy at DWR and she was saying that the other main centre for surgery/repair/bypass is Japan. She was saying that they have incredible case numbers and she has been over to visit them a few times.
All very interesting!!!
Scott 🙂
Replying to Emma Whitaker 30/08/2023 - 17:35
Emma!
Welcome. Such a joy to have you here!
I really hope you enjoy the course. I hope you don’t mind me sharing with the group…
Emma and I went to vet school together and I am very grateful that we are still friends to this day!
Scott x
Hello again.
Here is the reply I got back from my Hills contact today:
“Yes, unfortunately we have been struggling with the raw materials at our quality standards. Our z/d cat tinned has been particularly affected and we are anticipating a return to full stocking there in December/January.
However the dry is fully available. Hope this helps!”I was unaware of the shortage currently, we must have a secret store at my practice! 🙂
I also asked her regarding possible Hills alternatives and got the following reply:
“We do have the d/d single protein duck, however this is also only available in a dry for cats. But it would be a decent alternative if they needed a limited ingredient diet and just didn’t like the z/d but were ok with dry food in general.
https://www.hillsvet.co.uk/products/cat-food/pd-dd-feline-duck-and-green-pea-dryWe also find that about half of cats with IBD do well on the Gastrointestinal Biome rather than on a hydrolysed diet, so that’s worth trying and there is a dry, a stew tin and a pouch available.
https://www.hillsvet.co.uk/products/cat-food/pd-gastrointestinal-biome-feline-chicken-and-vegetable-stew-canned”I hope that helps!
Scott 🙂
Replying to Sarah Keir 30/08/2023 - 17:52
Interesting points, I did not realise there was such control regarding prescribing!
I must admit, I tend to send my owner to the internet for the Vivomixx!
Edinburgh are currently setting up a faecal bank. There are exploring frozen option etc… so your problem may be solved in the future!
Scott 🙂
Replying to Sarah Keir 29/08/2023 - 20:26
Hey.
I seem to have been lucky and avoided these supply issues! I have emailed my contacts at Hills and Purina regarding current supply. Will let you know what they say!
Hope you are having a lovely week.
Scott 🙂
Replying to Sarah Keir 29/08/2023 - 20:29
I was sorry to miss this meeting!
Really interesting topic. I am doing one this afternoon… not in a cat sadly.
What is your experience of using FMT?
Thanks again for sharing.
Scott 🙂
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